Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.
Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, China.
Front Cell Infect Microbiol. 2024 Feb 2;14:1338307. doi: 10.3389/fcimb.2024.1338307. eCollection 2024.
Metagenomic next-generation sequencing (mNGS) is a novel technique for detecting pathogens. This retrospective study evaluated the diagnostic value of mNGS using plasma for infections in hematology patients and its impact on clinical treatment and prognosis in different subgroups of hematology patients.
A total of 153 hematology patients with suspected infection who underwent mNGS using plasma were enrolled in the study. Their clinical histories, conventional microbiological test (CMT) results, mNGS results, treatment and prognosis were retrospectively analyzed.
In 153 plasma samples, mNGS yielded a higher positivity rate than CMT (total: 88.24% vs. 40.52%, P<0.001; bacteria: 35.95% vs. 21.57%, P < 0.01; virus: 69.93% vs. 21.57%, P<0.001; fungi: 20.26% vs. 7.84%, P<0.01). mNGS had a higher positivity rate for bacteria and fungi in the neutropenia group than in the non-neutropenia group (bacteria: 48.61% vs. 24.69%, P<0.01; fungi: 27.78% vs. 13.58%, P<0.05). mNGS demonstrated a greater advantage in the group of patients with hematopoietic stem cell transplantation (HSCT). Both the 3-day and 7-day efficacy rates in the HSCT group were higher than those in the non-HSCT group (3-day: 82.22% vs. 58.65%, P < 0.01; 7-day: 88.89% vs. 67.31%, P < 0.01), and the 28-day mortality rate was lower in the HSCT group than in the non-HSCT group (6.67% vs. 38.89%, P < 0.000). The neutropenia group achieved similar efficacy and mortality rates to the non-neutropenia group (7-day efficiency rate: 76.39% vs. 71.43%, P > 0.05; mortality rate: 29.17% vs. 29.63%, P > 0.05) with more aggressive antibiotic adjustments (45.83% vs. 22.22%, P < 0.01).
mNGS can detect more microorganisms with higher positive rates, especially in patients with neutropenia. mNGS had better clinical value in patients with hematopoietic stem cell transplantation (HSCT) or neutropenia, which had a positive effect on treatment and prognosis.
宏基因组下一代测序（mNGS）是一种用于检测病原体的新技术。本回顾性研究评估了 mNGS 检测血液系统疾病患者血浆感染的诊断价值及其对不同血液系统疾病患者亚组临床治疗和预后的影响。
共纳入 153 例疑似感染的血液系统疾病患者，采用 mNGS 检测血浆。回顾性分析其临床病史、常规微生物学检测（CMT）结果、mNGS 结果、治疗及预后。
在 153 份血浆样本中，mNGS 的阳性率高于 CMT（总阳性率：88.24%比 40.52%，P<0.001；细菌：35.95%比 21.57%，P < 0.01；病毒：69.93%比 21.57%，P<0.001；真菌：20.26%比 7.84%，P<0.01）。mNGS 检测中性粒细胞减少症组的细菌和真菌阳性率高于非中性粒细胞减少症组（细菌：48.61%比 24.69%，P<0.01；真菌：27.78%比 13.58%，P<0.05）。mNGS 在造血干细胞移植（HSCT）患者中具有更大的优势。HSCT 组的 3 天和 7 天疗效均高于非 HSCT 组（3 天：82.22%比 58.65%，P < 0.01；7 天：88.89%比 67.31%，P < 0.01），28 天死亡率低于非 HSCT 组（6.67%比 38.89%，P < 0.000）。中性粒细胞减少症组的疗效和死亡率与非中性粒细胞减少症组相似（7 天效率：76.39%比 71.43%，P > 0.05；死亡率：29.17%比 29.63%，P > 0.05），抗生素调整更为积极（45.83%比 22.22%，P < 0.01）。
mNGS 可以检测到更多具有更高阳性率的微生物，尤其是中性粒细胞减少症患者。mNGS 在造血干细胞移植（HSCT）或中性粒细胞减少症患者中具有更好的临床价值，对治疗和预后有积极影响。
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