OBJECTIVE

To investigate pathogen detection performance and diagnostic efficacy of bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) in patients with acute exacerbation of bronchiectasis (AE-bronchiectasis).

METHODS

A retrospective analysis was conducted on 78 patients with AE-bronchiectasis admitted to the First Affiliated Hospital of Guangxi Medical University from March 2020 to December 2023. Pathogen detection rates and diagnostic efficacy of conventional culture detection and BALF mNGS group were compared. Seventy-six patients diagnosed as positive by the gold standard were further stratified by bronchiectasis severity index (BSI) into mild-to-moderate and severe groups to analyze differences in pathogen profiles.

RESULTS

Compared to conventional culture, mNGS showed significantly higher detection rates for bacteria, fungi, and mycobacteria (all P<0.05), notably , , and (all P<0.05). In addition, mNGS exhibited superior diagnostic accuracy (94.87%) and sensitivity (94.74%) compared to conventional culture (P<0.05), with a higher area under the ROC curve (AUC=0.974). BSI stratification showed that the detection rates of fungi and viruses were higher in the severe group than those in the mild-to-moderate group, while the detection rate of bacteria was slightly lower than that in the mild-to-moderate group. The detection rate of in the severe group (51.06%) was significantly higher than that in the mild-to-moderate group (27.59%), while the detection rate of human herpesvirus 7 was significantly higher in the mild-to-moderate group (24.14%) compared to the severe group (4.26%) (all P<0.05).

CONCLUSION

BALF mNGS demonstrates clear advantages over conventional methods in pathogen detection for AE-bronchiectasis, offering significantly better detection rates and diagnostic efficiency.