Abstract：
Metagenomic next-generation sequencing (mNGS) is an unbiased and rapid method for detecting pathogens. This study enrolled 145 suspected severe pneumonia patients who were admitted to the Affiliated Hospital of Jining Medical University. This study primarily aimed to determine the diagnostic performance of mNGS and conventional microbiological tests (CMTs) using bronchoalveolar lavage fluid samples for detecting pathogens. Our findings indicated that mNGS performed significantly higher sensitivity (97.54% vs 28.68%, P < 0.001), coincidence (90.34% vs 35.17%, P < 0.001), and negative predictive value (80.00% vs 13.21%, P < 0.001) but performed lower specificity than CMTs (52.17% vs 87.5%, P < 0.001). Streptococcus pneumoniae as the most common bacterial pathogen had the largest proportion (22.90%, 30/131) in this study. In addition to bacteria, fungi, and virus, mNGS can detect a variety of atypical pathogens such as Mycobacterium tuberculosis and non-tuberculous. Mixed infections were common in patients with severe pneumonia, and bacterial-fungal-viral-atypical pathogens were the most complicated infection. After adjustments of antibiotics based on mNGS and CMTs, the clinical manifestation improved in 139 (95.86%, 139/145) patients. Our data demonstrated that mNGS had significant advantage in diagnosing respiratory tract infections, especially atypical pathogens and fungal infections. Pathogens were detected timely and comprehensively, contributing to the adjustments of antibiotic treatments timely and accurately, improving patient prognosis and decreasing mortality potentially.IMPORTANCEMetagenomic next-generation sequencing using bronchoalveolar lavage fluid can provide more comprehensive and accurate pathogens for respiratory tract infections, especially when considering the previous usage of empirical antibiotics before admission or complicated clinical presentation. This technology is expected to play an important role in the precise application of antimicrobial drugs in the future.
摘要：
宏基因组下一代测序（mNGS）是一种无偏快速检测病原体的方法。本研究纳入了济宁医学院附属医院收治的145例疑似重症肺炎患者。这项研究主要旨在确定使用支气管肺泡灌洗液样品检测病原体的mNGS和常规微生物测试（CMT）的诊断性能。我们的研究结果表明，mNGS表现出明显更高的灵敏度（97.54％vs28.68％，P<0.001)，巧合(90.34%对35.17%，P<0.001)，和阴性预测值（80.00%vs13.21%，P<0.001)，但特异性低于CMT(52.17%vs87.5%，P<0.001)。肺炎链球菌作为最常见的病原菌所占比例最大(22.90%,30/131）在这项研究中。除了细菌,真菌,和病毒,mNGS可以检测到多种非典型病原体，如结核分枝杆菌和非结核性。混合感染在重症肺炎患者中很常见，细菌-真菌-病毒-非典型病原体是最复杂的感染。在根据mNGS和CMT调整抗生素后，139例(95.86%,139/145）患者。我们的数据表明，mNGS在诊断呼吸道感染方面具有显著优势，尤其是非典型病原体和真菌感染。病原体检测及时、全面，有助于及时准确地调整抗生素治疗，改善患者预后并降低死亡率。IMPORTANCEMetagenomic使用支气管肺泡灌洗液的下一代测序可以为呼吸道感染提供更全面，更准确的病原体，尤其是考虑入院前使用经验性抗生素或复杂的临床表现时。该技术有望在未来抗菌药物的精准应用中发挥重要作用。
