Zhang Dan, Li Xingxing, Wang Yu, Zhao Yong, Zhang Hong
Department of Emergency Medicine, The First Affiliated Hospital of Anhui Medical University, Anhui, Hefei, China.
Front Microbiol. 2024 Apr 15;15:1384166. doi: 10.3389/fmicb.2024.1384166. eCollection 2024.
Although metagenomic next-generation sequencing (mNGS) is commonly used for diagnosing infectious diseases, clinicians face limited options due to the high costs that are not covered by basic medical insurance. The goal of this research is to challenge this bias through a thorough examination and evaluation of the clinical importance of mNGS in precisely identifying pathogenic microorganisms in cases of sepsis acquired in the community or in hospitals.
A retrospective observational study took place at a tertiary teaching hospital in China from January to December 2021. Data on 308 sepsis patients were collected, and the performance of etiological examination was compared between mNGS and traditional culture method.
Two hundred twenty-nine cases were observed in the community-acquired sepsis (CAS) group and 79 cases in the hospital-acquired sepsis (HAS) group. In comparison with conventional culture, mNGS showed a significantly higher rate of positivity in both the CAS group (88.21% vs. 25.76%, adj. < 0.001) and the HAS group (87.34% vs. 44.30%, adj. < 0.001), particularly across various infection sites and specimens, which were not influenced by factors like antibiotic exposure or the timing and frequency of mNGS technology. Sepsis pathogens detected by mNGS were broad, especially viruses, , and atypical pathogens, with mixed pathogens being common, particularly bacterial-viral co-detection. Based on the optimization of antimicrobial therapy using mNGS, 58 patients underwent antibiotic de-escalation, two patients were switched to antiviral therapy, and 14 patients initiated treatment for tuberculosis, resulting in a reduction in antibiotic overuse but without significant impact on sepsis prognosis. The HAS group exhibited a critical condition, poor prognosis, high medical expenses, and variations in etiology, yet the mNGS results did not result in increased medical costs for either group.
mNGS demonstrates efficacy in identifying multiple pathogens responsible for sepsis, with mixed pathogens of bacteria and viruses being prevalent. Variability in microbiological profiles among different infection setting underscores the importance of clinical vigilance. Therefore, the adoption of mNGS for microbiological diagnosis of sepsis warrants acknowledgment and promotion.
尽管宏基因组下一代测序（mNGS）常用于诊断感染性疾病，但由于基本医疗保险不涵盖其高昂费用，临床医生面临的选择有限。本研究的目的是通过全面检查和评估mNGS在准确识别社区获得性或医院获得性败血症病例中的致病微生物方面的临床重要性，来挑战这种偏见。
2021年1月至12月在中国一家三级教学医院进行了一项回顾性观察研究。收集了308例败血症患者的数据，并比较了mNGS和传统培养方法在病因学检查方面的表现。
社区获得性败血症（CAS）组观察到229例，医院获得性败血症（HAS）组观察到79例。与传统培养相比，mNGS在CAS组（88.21%对25.76%，校正后<0.001）和HAS组（87.34%对44.30%，校正后<0.001）中的阳性率均显著更高，特别是在各种感染部位和标本中，且不受抗生素暴露或mNGS技术的时间和频率等因素影响。mNGS检测到的败血症病原体种类广泛，尤其是病毒和非典型病原体，混合病原体很常见，特别是细菌-病毒联合检测。基于mNGS优化抗菌治疗后，58例患者抗生素降级，2例患者改为抗病毒治疗，14例患者开始抗结核治疗，减少了抗生素的过度使用，但对败血症预后无显著影响。HAS组病情危急、预后差、医疗费用高且病因各异，但mNGS结果并未导致两组医疗费用增加。
mNGS在识别导致败血症的多种病原体方面显示出有效性，细菌和病毒的混合病原体很普遍。不同感染环境下微生物谱的差异凸显了临床警惕的重要性。因此，采用mNGS进行败血症的微生物诊断值得认可和推广。
