Guo Na, Ma Guannan, Liu Huimin, Qiu Jingxuan, Yu Yan, Gao Yunlei, Yi Zhong, Wan Zhirong, Zhang Lei, Wu Xiaorui
Department of Geriatrics, Aerospace Center Hospital, Beijing, People's Republic of China.
Medical Research Center, Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Hangzhou, People's Republic of China.
Infect Drug Resist. 2025 Sep 9;18:4811-4816. doi: 10.2147/IDR.S543666. eCollection 2025.
Severe pneumonia with empyema in elderly patients presents diagnostic and therapeutic challenges. Traditional culture methods often fail to identify the causative pathogen, leading to delays in targeted treatment. Metagenomic next-generation sequencing (mNGS) has emerged as a powerful tool for detecting rare and fastidious pathogens.
We report a 77-year-old male with a history of chronic smoking and alcohol consumption who presented with a two-month history of cough, sputum production, and progressive dyspnea. His condition rapidly deteriorated with high fever and respiratory failure. Initial antibiotic therapy was ineffective, and multiple cultures of blood, sputum, and pleural fluid were negative. However, mNGS of blood and pleural fluid identified , a well-known periodontal pathogen rarely associated with pulmonary infections. The patient's treatment was adjusted to include targeted anaerobic coverage (imipenem plus vancomycin) alongside chest tube drainage, leading to significant clinical improvement.
This case highlights the clinical utility of mNGS in diagnosing culture-negative pulmonary infections. should be considered a potential pathogen in patients with severe pneumonia and empyema, particularly in those with poor oral hygiene or periodontal disease.
老年患者的重症肺炎合并脓胸带来了诊断和治疗方面的挑战。传统培养方法常常无法鉴定出致病病原体，导致针对性治疗延误。宏基因组下一代测序（mNGS）已成为检测罕见及苛求病原体的有力工具。
我们报告一名77岁男性，有长期吸烟和饮酒史，出现咳嗽、咳痰及进行性呼吸困难2个月。他的病情迅速恶化，出现高热和呼吸衰竭。初始抗生素治疗无效，多次血、痰及胸水培养均为阴性。然而，血和胸水的mNGS鉴定出 ，这是一种很少与肺部感染相关的知名牙周病原体。患者的治疗调整为包括针对性的厌氧菌覆盖（亚胺培南加万古霉素）及胸腔闭式引流，临床症状显著改善。
本病例突出了mNGS在诊断培养阴性肺部感染中的临床应用价值。 在重症肺炎合并脓胸患者中应被视为潜在病原体，尤其是口腔卫生差或患有牙周疾病的患者。 （注：原文中“identified ”后面似乎缺失了具体病原体信息）
