Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China.
Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, 210008, Jiangsu, China.
Infection. 2024 Apr;52(2):625-636. doi: 10.1007/s15010-024-02185-1. Epub 2024 Feb 18.
Infectious etiologies of lower respiratory tract infections (LRTIs) by the conventional microbiology tests (CMTs) can be challenging. Metagenomic next-generation sequencing (mNGS) has great potential in clinical use for its comprehensiveness in identifying pathogens, particularly those difficult-to-culture organisms.
We analyzed a total of 205 clinical samples from 201 patients with suspected LRTIs using mNGS in parallel with CMTs. mNGS results were used to guide treatment adjustments for patients who had negative CMT results. The efficacy of treatment was subsequently evaluated in these patients.
mNGS-detected microorganisms in 91.7% (188/205) of the clinical samples, whereas CMTs demonstrated a lower detection rate, identifying microorganisms in only 37.6% (77/205) of samples. Compared to CMT results, mNGS exhibited a detection sensitivity of 93.5% and 95.4% in all 205 clinical samples and 180 bronchoalveolar lavage fluid (BALF) samples, respectively. A total of 114 patients (114/201; 56.7%) showed negative CMT results, among which 92 received treatment adjustments guided by their positive mNGS results. Notably, 67.4% (62/92) of patients demonstrated effective treatment, while 25% (23/92) experienced a stabilized condition. Subgroup analysis of cancer patients revealed that 41.9% (13/31) exhibited an effective response to treatment, and 35.5% (11/31) maintained a stable condition following medication adjustments guided by mNGS.
mNGS demonstrated great potential in identifying microorganisms of clinical significance in LRTIs. The rapid turnaround time and reduced susceptibility to the impact of antimicrobial administration make mNGS a valuable supplementary tool for diagnosis and treatment decision-making for suspected LRTIs in clinical practice.
传统微生物学检测（CMTs）对下呼吸道感染（LRTIs）的感染病因的检测具有挑战性。宏基因组下一代测序（mNGS）在识别病原体方面具有很大的临床应用潜力，特别是那些难以培养的生物。
我们对 201 例疑似 LRTIs 患者的 205 份临床样本进行了 mNGS 与 CMTs 的平行分析。mNGS 结果用于指导对 CMT 结果为阴性的患者进行治疗调整。随后对这些患者的治疗效果进行评估。
mNGS 在 91.7%（188/205）的临床样本中检测到微生物，而 CMTs 的检测率较低，仅在 37.6%（77/205）的样本中检测到微生物。与 CMT 结果相比，mNGS 在所有 205 份临床样本和 180 份支气管肺泡灌洗液（BALF）样本中的检测灵敏度分别为 93.5%和 95.4%。共有 114 例（114/201；56.7%）患者 CMT 结果为阴性，其中 92 例根据阳性 mNGS 结果进行了治疗调整。值得注意的是，67.4%（62/92）的患者治疗有效，25%（23/92）的患者病情稳定。对癌症患者的亚组分析显示，41.9%（13/31）的患者经 mNGS 指导药物调整后治疗有效，35.5%（11/31）的患者病情稳定。
mNGS 在识别 LRTIs 中有临床意义的微生物方面具有很大的潜力。mNGS 具有快速的周转时间和降低对抗菌药物治疗影响的敏感性，使其成为临床实践中疑似 LRTIs 诊断和治疗决策的有价值的辅助工具。
