Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No.160 Pujian Road, Shanghai, China.
Jiading Branch, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Clin Microbiol Antimicrob. 2024 Sep 30;23(1):88. doi: 10.1186/s12941-024-00749-5.
Accurate identification of the etiology of lower respiratory tract infections (LRTI) is crucial, particularly for immunocompromised patients with more complex etiologies. The advent of next-generation sequencing (NGS) has enhanced the effectiveness of pathogen detection. However, assessments of the clinical diagnostic value of targeted NGS (tNGS) in immunocompromised patients with LRTI are limited.
To evaluate the diagnostic value of tNGS in immunocompromised patients with LRTI, a total of 88 patients, of whom 54 were immunocompromised, were enrolled. These patients underwent tNGS testing of bronchoalveolar lavage fluid (BALF). Results from both metagenomic next-generation sequencing (mNGS) and conventional microbiological tests (CMT) were also available for all participants. The performance of tNGS was assessed by comparing its findings against mNGS, CMT, and the clinical composite diagnosis.
In the cohort of 88 patients, tNGS showed comparable diagnostic value to mNGS and was significantly superior to CMT. Compared to CMT and composite reference standard, tNGS showed sensitivity of 94.55% and 90.48%, respectively. In immunocompromised patients, despite a more diverse pathogen variety, tNGS maintained similar sensitivity to mNGS and outperformed CMT. tNGS positively influenced etiologic diagnosis and antibiotic decision-making in 72.72% of cases, leading to a change in antibiotic regimen in 17.05% of cases. We also compared the detection of microbial nucleic acids by tNGS with mNGS and found that tNGS could identify 87.99% of the microbial nucleic acids identified by mNGS.
In summary, our study demonstrated that tNGS offers promising clinical diagnostic accuracy in immunocompromised patients, as evidenced by its favorable comparison with CMT, the composite reference standard, and mNGS.
准确识别下呼吸道感染（LRTI）的病因至关重要，特别是对于病因更为复杂的免疫功能低下患者。下一代测序（NGS）的出现提高了病原体检测的有效性。然而，靶向 NGS（tNGS）在 LRTI 免疫功能低下患者中的临床诊断价值评估有限。
为了评估 tNGS 在 LRTI 免疫功能低下患者中的诊断价值，共纳入 88 例患者，其中 54 例为免疫功能低下患者。这些患者接受了支气管肺泡灌洗液（BALF）的 tNGS 检测。所有参与者的宏基因组下一代测序（mNGS）和常规微生物学检测（CMT）结果也可获得。通过将 tNGS 的结果与 mNGS、CMT 和临床综合诊断进行比较，评估 tNGS 的性能。
在 88 例患者队列中，tNGS 的诊断价值与 mNGS 相当，明显优于 CMT。与 CMT 和综合参考标准相比，tNGS 的敏感性分别为 94.55%和 90.48%。在免疫功能低下患者中，尽管病原体种类更为多样化，但 tNGS 与 mNGS 保持相似的敏感性，且优于 CMT。tNGS 在 72.72%的病例中对病因诊断和抗生素决策产生了积极影响，导致 17.05%的病例改变了抗生素方案。我们还比较了 tNGS 和 mNGS 检测微生物核酸的能力，发现 tNGS 可以识别 mNGS 鉴定的 87.99%的微生物核酸。
总之，我们的研究表明，tNGS 在免疫功能低下患者中具有有前途的临床诊断准确性，其与 CMT、综合参考标准和 mNGS 的有利比较证明了这一点。
