Chen Xiaopu, Liang Yong, Yang Wei, He Wenzhen, Xing Zhiqiang, Li Shunxian, Cai Shaoyu, Fu Jiping, Peng Xiaotang, Chen Manli, Wu Jiaming
Department of Neurology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China.
Front Cell Infect Microbiol. 2025 Jan 8;14:1386377. doi: 10.3389/fcimb.2024.1386377. eCollection 2024.
Metagenomic high-throughput sequencing (mNGS) represents a powerful tool for detecting nucleic acids from various pathogens, such as bacteria, fungi, viruses and parasites, in clinical samples. Despite its extensively employed in the pathogen diagnosis for various infectious diseases, its application in diagnosing stroke-related infection, and its potential impact on clinical decision-making, anti-infection treatment, clinical intervention, and patient prognosis remain insufficiently explored. Additionally, while mNGS offers promising potential, it facts limitations related to sensitivity, specificity, cost, and standardization, which could influence its integration into routine clinical practice.
We retrospectively analyzed 18 stroke patients admitted to the First Affiliated Hospital of Medical College of Shantou University from January to February 2023, comparing culture-based methods with mNGS detection, and assessing its significance in etiological diagnosis. Additionally, we evaluated the performance differences among various sequencing platforms.
Among the 18 stroke patients enrolled, pulmonary infections were identified in 7 cases, urinary tract infections in 1 case, central nervous system infections in 10 cases, and combined pulmonary and central nervous system infections in 2 cases, with 2 cases yielding negative results. mNGS detected pathogens in 13 cases, aligning with clinical diagnoses (75% concordance), whereas culture-based methods yielded positive results in only 6 cases (22% concordance). Importantly, for 9 of the 18 patients, adjustments to anti-infective treatment regimens based on mNGS results led to improved symptomatic relief and infection control. This suggests that mNGS can contribute to more timely and precise treatment modifications, particularly for infections with low pathogen loads, potentially enhancing clinical outcomes.
Our findings highlights the utility of mNGS in diagnosing stroke-associated infections by providing a more comprehensive etiological diagnosis compared to traditional method. While mNGS shows promise in enhancing diagnostic accuracy and guiding clinical treatment, it high cost and technical challenges need addressing before widespread clinical adoption. Future research should focus on optimizing mNGS protocols, integration it with convertional diagnostic tools, and evaluating its cost-effectiveness and clinical impact through larger, multicentric studies.
宏基因组高通量测序（mNGS）是一种强大的工具，可用于检测临床样本中来自各种病原体（如细菌、真菌、病毒和寄生虫）的核酸。尽管它已广泛应用于各种传染病的病原体诊断，但其在诊断与中风相关的感染以及对临床决策、抗感染治疗、临床干预和患者预后的潜在影响方面仍未得到充分探索。此外，虽然mNGS具有广阔的潜力，但它存在与灵敏度、特异性、成本和标准化相关的局限性，这可能会影响其融入常规临床实践。
我们回顾性分析了2023年1月至2月在汕头大学医学院第一附属医院收治的18例中风患者，将基于培养的方法与mNGS检测进行比较，并评估其在病因诊断中的意义。此外，我们还评估了各种测序平台之间的性能差异。
在纳入的18例中风患者中，7例被诊断为肺部感染，1例为尿路感染，10例为中枢神经系统感染，2例为肺部和中枢神经系统合并感染，2例结果为阴性。mNGS在13例中检测到病原体，与临床诊断相符（一致性为75%），而基于培养的方法仅在6例中得出阳性结果（一致性为22%）。重要的是，在18例患者中的9例中，根据mNGS结果调整抗感染治疗方案后，症状缓解和感染控制得到改善。这表明mNGS有助于更及时、精确地调整治疗方案，特别是对于病原体载量低的感染，可能会改善临床结局。
我们的研究结果突出了mNGS在诊断与中风相关的感染中的效用，与传统方法相比，它能提供更全面的病因诊断。虽然mNGS在提高诊断准确性和指导临床治疗方面显示出前景，但在广泛应用于临床之前，其高成本和技术挑战需要解决。未来的研究应专注于优化mNGS方案，将其与传统诊断工具整合，并通过更大规模的多中心研究评估其成本效益和临床影响。
