Chen Yongru, Chen Chongyue, Chen Wei, Gai Wei, Zheng Yafeng, Guo Yuxin, Wang Zhaoning, Chen Yongsong, Cai Zhiming
The First Affiliated Hospital of Shantou University, Shantou, Guangdong, People's Republic of China.
Department of Urology, Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, International Cancer Center, Shenzhen University School of Medicine, Shenzhen, People's Republic of China.
Infect Drug Resist. 2024 Oct 26;17:4695-4706. doi: 10.2147/IDR.S485102. eCollection 2024.
This study aimed to evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) in sepsis patients who received early empirical antibiotic treatment.
A retrospective analysis was conducted on clinical data from sepsis patients diagnosed in the Emergency Intensive Care Unit (EICU) between April 2019 and May 2023. All patients underwent standard conventional microbiological testing. Patients were categorized into either the mNGS group or the control group based on whether they underwent mNGS tests. Baseline variables were matched using propensity scores.
Out of 461 sepsis patients screened, 130 were included after propensity matching, with 65 patients in each group. Despite prior antibiotic treatment, 57 cases (87.69%) in the mNGS group had positive mNGS results, exceeding the culture detection rate (52.31%). Besides, a higher proportion of patients in the mNGS group experienced antibiotic adjustments compared to the control group (72.31% vs 53.85%). Mortality rates were also compared based on the duration of antibiotic exposure before mNGS sampling. Patients exposed to antibiotics for less than 24 hours had a lower mortality rate compared to those exposed for over 8 days (22.22% vs 42.86%). COX multivariate analysis identified mNGS testing, underlying diseases, lymphocyte percentage, infection site (respiratory and bloodstream) as independent risk factors for mortality in sepsis patients.
With increased antibiotic exposure time, the positive rate of culture testing significantly decreased (44.44% vs 59.52% vs 35.71%, = 0.031), whereas the positive rate of mNGS remained stable (77.78% vs 88.10% vs 92.86%, = 0.557). mNGS demonstrated less susceptibility to antibiotic exposure. Early mNGS detection positively impacted the prognosis of sepsis patients.
本研究旨在评估宏基因组下一代测序（mNGS）在接受早期经验性抗生素治疗的脓毒症患者中的临床应用价值。
对2019年4月至2023年5月在急诊重症监护病房（EICU）诊断为脓毒症的患者的临床资料进行回顾性分析。所有患者均接受标准的传统微生物检测。根据患者是否接受mNGS检测，将其分为mNGS组或对照组。使用倾向得分匹配基线变量。
在筛查的461例脓毒症患者中，倾向匹配后纳入130例，每组65例。尽管进行了先前的抗生素治疗，但mNGS组中有57例（87.69%）的mNGS结果为阳性，超过了培养检测率（52.31%）。此外，与对照组相比，mNGS组中经历抗生素调整的患者比例更高（72.31%对53.85%）。还根据mNGS采样前抗生素暴露时间比较了死亡率。抗生素暴露少于24小时的患者死亡率低于暴露超过8天的患者（22.22%对42.86%）。COX多变量分析确定mNGS检测、基础疾病、淋巴细胞百分比、感染部位（呼吸道和血流）是脓毒症患者死亡的独立危险因素。
随着抗生素暴露时间增加，培养检测的阳性率显著降低（44.44%对59.52%对35.71%，P = 0.031），而mNGS的阳性率保持稳定（77.78%对88.10%对92.86%，P = 0.557）。mNGS对抗生素暴露的敏感性较低。早期mNGS检测对脓毒症患者的预后有积极影响。
