Division of Respiratory and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.
Department of Oral and Maxillofacial Oncology Surgery, the First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.
Medicine (Baltimore). 2023 Dec 15;102(50):e36519. doi: 10.1097/MD.0000000000036519.
This study used metagenomic next-generation sequencing (mNGS) technology to explore the changes of the microbial characteristics in the lower respiratory tract in patients with acute exacerbations of bronchiectasis (noncystic fibrosis) to guide clinical treatment and improve patients' quality of life and prognosis. This prospective study included 54 patients with acute exacerbation and 46 clinically stable patients admitted to the Respiratory and Critical Care Medicine Center of the People's Hospital of Xinjiang Uygur Autonomous Region from January 2020 to July 2022. Sputum was subjected to routine microbiological tests, and bronchoalveolar lavage fluid (BALF) samples were subjected to microbiological tests and mNGS of BALF before empirical antibiotic therapy. Serum inflammatory markers (white blood cell count, interleukin-6, procalcitonin, and C-reactive protein) were measured. In addition, we evaluated the pathogen of mNGS and compared the airway microbiome composition of patients with acute exacerbation and control patients. The mean age of our cohort was 56 ± 15.2 years. Eighty-nine patients had positive results by mNGS. There was a significant difference in the detection of viruses between the groups (χ2 = 6.954, P < .01). The fungal species Candida albicans, Pneumocystis jirovecii, and Aspergillus fumigatus were significantly more common in patients with acute exacerbations (χ2 = 5.98, P = .014). The bacterial species Acinetobacter baumannii, Mycobacterium tuberculosis, Haemophilus influenzae, Haemophilus parahaemolyticus, Abiotrophia defectiva, and Micromonas micros were significantly more prevalent in patients with acute exacerbations (χ2 = 4.065, P = .044). The most common bacterial species isolated from the sputum and BALF samples of patients with acute exacerbation was A. baumannii. Chlamydia psittaci was found in 4 patients. In addition, of 77 patients with negative sputum culture, 66 had positive results by mNGS, demonstrating the increased sensitivity and accuracy of mNGS. Patients with acute exacerbation of bronchiectasis tend to have mixed infections in the lower respiratory tract. The frequency of viruses, fungi, and Mycoplasma was higher in these patients. Our findings suggest that mNGS could be used to identify pathogenic microorganisms in these patients, increasing the effectiveness of antibiotic therapy.
本研究采用宏基因组下一代测序（mNGS）技术，探索非囊性纤维化支气管扩张症急性加重患者下呼吸道微生物特征的变化，以指导临床治疗，提高患者生活质量和预后。本前瞻性研究纳入 2020 年 1 月至 2022 年 7 月期间新疆维吾尔自治区人民医院呼吸与危重症医学中心收治的 54 例急性加重期患者和 46 例临床稳定期患者。对患者痰液进行常规微生物学检查，在经验性抗生素治疗前对支气管肺泡灌洗液（BALF）标本进行微生物学检查和 mNGS。检测血清炎症标志物（白细胞计数、白细胞介素-6、降钙素原和 C 反应蛋白）。此外，我们评估了 mNGS 的病原体，并比较了急性加重期患者和对照组患者的气道微生物组组成。我们队列的平均年龄为 56±15.2 岁。89 例患者 mNGS 检测结果阳性。两组病毒检测结果有显著差异（χ2=6.954，P<.01）。急性加重期患者真菌种类白色念珠菌、卡氏肺孢子菌和烟曲霉明显更为常见（χ2=5.98，P=.014）。急性加重期患者鲍曼不动杆菌、结核分枝杆菌、流感嗜血杆菌、副流感嗜血杆菌、缺陷拟杆菌和微小微单胞菌等细菌种类明显更为常见（χ2=4.065，P=.044）。急性加重期患者痰和 BALF 标本分离的最常见细菌种类是鲍曼不动杆菌。4 例患者检出鹦鹉热衣原体。此外，77 例痰培养阴性的患者中，66 例 mNGS 检测结果阳性，表明 mNGS 的灵敏度和准确性更高。支气管扩张症急性加重患者下呼吸道多为混合感染，病毒、真菌和支原体的检出率较高。我们的研究结果表明，mNGS 可用于识别这些患者的致病微生物，提高抗生素治疗的效果。
