PDF(Pubmed)
Abstract：
Immunosuppression predisposes allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients to infection. Prompt and accurate identification of pathogens is crucial to optimize treatment strategies. This multi-center retrospective study aimed to assess the ability of metagenomic next-generation sequencing (mNGS) to detect causative pathogens in febrile allo-HSCT recipients and examined its concordance with conventional microbiological tests (CMT).
We performed mNGS and CMT on samples obtained from 153 patients with suspected infection during allo-HSCT. Patients were grouped based on their neutropenic status at the time of sampling.
The mNGS test was more sensitive than CMT (81.1% vs. 53.6%, P<0.001) for diagnosing clinically suspected infection, especially in the non-neutropenia cohort. mNGS could detect fungi and viruses better than bacteria, with a higher sensitivity than CMT. Immune events were diagnosed in 57.4% (35/61) of the febrile events with negative mNGS results, and 33.5% (48/143) with negative CMT results (P=0.002). The treatment success rate of the targeted anti-infection strategy was significantly higher when based on mNGS than on empirical antibiotics (85% vs. 56.5%, P=0.004).
The mNGS test is superior to CMT for identifying clinically relevant pathogens, and provides valuable information for anti-infection strategies in allo-HSCT recipients. Additionally, attention should be paid to immune events in patients with negative mNGS results.
We performed mNGS and CMT on samples obtained from 153 patients with suspected infection during allo-HSCT. Patients were grouped based on their neutropenic status at the time of sampling.
The mNGS test was more sensitive than CMT (81.1% vs. 53.6%, P<0.001) for diagnosing clinically suspected infection, especially in the non-neutropenia cohort. mNGS could detect fungi and viruses better than bacteria, with a higher sensitivity than CMT. Immune events were diagnosed in 57.4% (35/61) of the febrile events with negative mNGS results, and 33.5% (48/143) with negative CMT results (P=0.002). The treatment success rate of the targeted anti-infection strategy was significantly higher when based on mNGS than on empirical antibiotics (85% vs. 56.5%, P=0.004).
The mNGS test is superior to CMT for identifying clinically relevant pathogens, and provides valuable information for anti-infection strategies in allo-HSCT recipients. Additionally, attention should be paid to immune events in patients with negative mNGS results.
摘要：
■免疫抑制使异基因造血干细胞移植（allo-HSCT）受者容易感染。及时准确地识别病原体对于优化治疗策略至关重要。这项多中心回顾性研究旨在评估宏基因组下一代测序（mNGS）在高热allo-HSCT接受者中检测致病病原体的能力，并检查其与常规微生物学测试（CMT）的一致性。
■我们对在allo-HSCT期间从153例疑似感染患者获得的样本进行了mNGS和CMT。根据取样时的中性粒细胞减少状态对患者进行分组。
■mNGS测试比CMT更敏感（81.1%vs.53.6%,P<0.001）用于诊断临床可疑感染，尤其是在非中性粒细胞减少症队列中。mNGS可以比细菌更好地检测真菌和病毒，具有比CMT更高的灵敏度。57.4%(35/61)的高热事件诊断为免疫事件，mNGS结果为阴性。33.5%(48/143)的CMT结果为阴性(P=0.002)。基于mNGS的靶向抗感染策略的治疗成功率明显高于经验性抗生素（85％vs.56.5%,P=0.004)。
■在识别临床相关病原体方面，mNGS测试优于CMT，并为allo-HSCT受者的抗感染策略提供了有价值的信息。此外,mNGS结果阴性的患者应注意免疫事件。
■我们对在allo-HSCT期间从153例疑似感染患者获得的样本进行了mNGS和CMT。根据取样时的中性粒细胞减少状态对患者进行分组。
■mNGS测试比CMT更敏感（81.1%vs.53.6%,P<0.001）用于诊断临床可疑感染，尤其是在非中性粒细胞减少症队列中。mNGS可以比细菌更好地检测真菌和病毒，具有比CMT更高的灵敏度。57.4%(35/61)的高热事件诊断为免疫事件，mNGS结果为阴性。33.5%(48/143)的CMT结果为阴性(P=0.002)。基于mNGS的靶向抗感染策略的治疗成功率明显高于经验性抗生素（85％vs.56.5%,P=0.004)。
■在识别临床相关病原体方面，mNGS测试优于CMT，并为allo-HSCT受者的抗感染策略提供了有价值的信息。此外,mNGS结果阴性的患者应注意免疫事件。
