血浆与支气管肺泡灌洗液相联合的宏基因组下一代测序在肺炎源性脓毒症患者中的临床应用价值

Clinical application value of simultaneous plasma and bronchoalveolar lavage fluid metagenomic next generation sequencing in patients with pneumonia-derived sepsis.

作者信息

Li Jiayan, Pan Dongxu, Guo Yuxin, Zhang Bo, Lu Xinglin, Deng Chen, Xu Feifei, Lv Zongnan, Chen Qinhe, Zheng Yafeng, Nong Shuhao, Su Lihua, Qin Rongfa, Jiang Fufu, Gai Wei, Qin Gang

机构信息

Department of Intensive Care Unit, National Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.

WillingMed Technology (Beijing) Co., Ltd, Beijing, China.

出版信息

BMC Infect Dis. 2024 Dec 6;24(1):1393. doi: 10.1186/s12879-024-10292-5.

DOI:10.1186/s12879-024-10292-5

PMID:39639243

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11622652/

Abstract

BACKGROUND

Despite the increasing use of metagenomic next-generation sequencing (mNGS) in sepsis, identifying clinically relevant pathogens remains challenging. This study was aimed to evaluate the clinical utility of simultaneous plasma and bronchoalveolar lavage fluid (BALF) detection using mNGS.

METHODS

This retrospective study enrolled 95 patients with pneumonia-derived sepsis (PDS) admitted to the intensive care unit (ICU) between October 2021 and January 2023. Patients were divided into two groups: mNGS group (n = 60) and the non-mNGS group (n = 35), based on whether simultaneous plasma and BALF mNGS were conducted. All patients underwent conventional microbiological tests (CMT), including bacterial/fungal culture of peripheral blood and BALF, as well as sputum culture, detection of 1, 3-beta-D- glucan in BALF and RT-PCR testing. The clinical data of the enrolled patients were collected, and the detection performance and prognosis of plasma mNGS, BALF mNGS and CMT were compared.

RESULTS

The mNGS group exhibited a lower mortality rate than the non-mNGS group (35.0% vs. 57.1%, P = 0.034). Simultaneous detection in dual-sample resulted in a higher proportion of microorganisms identified as definite causes of sepsis alert compared to detection in either plasma or BALF alone (55.6% vs. 20.8% vs. 18.8%, P<0.001). Acinetobacter baumannii, Stenotrophomonas maltophilia, Candida albicans, and human mastadenovirus B were the primary strains responsible for infections in PDS patients. Patients with lower white blood cells and neutrophil indices had a greater consistency in dual-sample mNGS. Patients in the mNGS group had more antibiotic adjustments compared to the non-mNGS group (85.71% vs. 33.33%, P<0.001). The percentage of neutrophils was a risk factor for mortality in PDS patients (P = 0.002).

CONCLUSION

Dual sample mNGS has the advantage of detecting and determining the pathogenicity of more pathogens and has the potential to improve the prognosis of patients with PDS.

摘要

背景

尽管宏基因组下一代测序（mNGS）在脓毒症中的应用日益增加，但识别临床相关病原体仍然具有挑战性。本研究旨在评估使用mNGS同时检测血浆和支气管肺泡灌洗液（BALF）的临床效用。

方法

这项回顾性研究纳入了2021年10月至2023年1月期间入住重症监护病房（ICU）的95例肺炎源性脓毒症（PDS）患者。根据是否同时进行血浆和BALF的mNGS检测，将患者分为两组：mNGS组（n = 60）和非mNGS组（n = 35）。所有患者均接受常规微生物学检测（CMT），包括外周血和BALF的细菌/真菌培养、痰培养、BALF中1,3-β-D-葡聚糖的检测以及逆转录聚合酶链反应（RT-PCR）检测。收集纳入患者的临床资料，比较血浆mNGS、BALF mNGS和CMT的检测性能及预后。

结果

mNGS组的死亡率低于非mNGS组（35.0%对57.1%，P = 0.034）。与单独检测血浆或BALF相比，双样本同时检测确定为脓毒症警报明确病因的微生物比例更高（55.6%对20.8%对18.8%，P<0.001）。鲍曼不动杆菌、嗜麦芽窄食单胞菌、白色念珠菌和人B型乳腺病毒是PDS患者感染的主要菌株。白细胞和中性粒细胞指数较低的患者在双样本mNGS中具有更高的一致性。与非mNGS组相比，mNGS组的抗生素调整更多（85.71%对33.33%，P<0.001）。中性粒细胞百分比是PDS患者死亡的危险因素（P = 0.002）。