Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
BMC Pulm Med. 2024 Sep 27;24(1):478. doi: 10.1186/s12890-024-03301-5.
Pulmonary infection is one of the leading causes of death in patients with ANCA-associated vasculitis (AAV). It is sometimes difficult to differentiate pulmonary infection from pulmonary involvement of vasculitis in AAV patients. Fiberoptic bronchoscopy and bronchoalveolar lavage fluid (BALF) assays are useful diagnostic methods. In addition to conventional microbiological tests (CMTs), metagenomic next-generation sequencing (mNGS) facilitates rapid and sensitive detection of various pathogens. The current study aimed to evaluate the advantages of additional BALF mNGS in the management of pulmonary infection in AAV patients.
27 patients with active AAV and suspected pulmonary infection whose BALF samples were tested by mNGS and CMTs and 17 active AAV patients whose BALF were tested by CMTs alone were retrospectively recruited. The results of microbiological tests, and adjustments of treatment following BALF mNGS, were described. The durations of antimicrobial treatment and in-hospital mortality in patients were compared.
Among the 27 patients whose BALF samples were tested by mNGS, 25.9% of patients did not have evidence of pathogenic microorganism in their BALF samples, 55.6% had polymicrobial infections, including bacteria, fungi and viruses. Of these 27 patients, 40.7% did not have evidence of pathogenic microorganism in their BALF or serum samples according to CMTs. Patients in the BALF mNGS/CMT group received a significantly shorter duration of antibacterial and total antimicrobial treatment than patients in the CMT alone group (17.3 ± 14.7 vs. 27.9 ± 19.0 days, P = 0.044; 18.9 ± 15.0 vs. 29.5 ± 17.7 days, P = 0.040, respectively). Fewer patients in the BALF mNGS/CMT group died than in the CMT alone group (4/27 vs. 7/17, P = 0.049).
Compared with CMT alone, additional mNGS tests may shorten the duration of antimicrobial treatment and possibly decrease death from severe infection by providing precise and quick diagnosis of infection.
肺部感染是抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）患者死亡的主要原因之一。有时，很难将 AAV 患者的肺部感染与血管炎的肺部受累区分开来。纤维支气管镜检查和支气管肺泡灌洗液（BALF）检测是有用的诊断方法。除了常规微生物学检测（CMTs）外，宏基因组下一代测序（mNGS）有助于快速、敏感地检测各种病原体。本研究旨在评估 BALF mNGS 对 AAV 患者肺部感染管理的优势。
回顾性招募了 27 例接受纤维支气管镜检查和 BALF mNGS 及 CMTs 检测的活动期 AAV 伴疑似肺部感染患者，以及 17 例仅接受 CMTs 检测的活动期 AAV 患者。描述了微生物学检测结果以及根据 BALF mNGS 结果调整治疗。比较了患者的抗菌治疗持续时间和住院死亡率。
在接受 BALF mNGS 检测的 27 例患者中，25.9%的患者 BALF 样本中无致病微生物证据，55.6%的患者存在混合感染，包括细菌、真菌和病毒。在这 27 例患者中，根据 CMTs，40.7%的患者 BALF 或血清样本中无致病微生物证据。BALF mNGS/CMT 组患者的抗菌和总抗菌治疗持续时间明显短于 CMT 组（17.3±14.7 天 vs. 27.9±19.0 天，P=0.044；18.9±15.0 天 vs. 29.5±17.7 天，P=0.040）。BALF mNGS/CMT 组的死亡人数少于 CMT 组（4/27 例 vs. 7/17 例，P=0.049）。
与单独 CMT 相比，额外的 mNGS 检测可通过提供更准确、快速的感染诊断来缩短抗菌治疗的持续时间，并可能降低因严重感染而死亡的风险。
