■宏基因组下一代测序(mNGS)通常被应用,因为它能够在不依赖于培养的情况下识别和分类所有感染,并以无偏见的方式检索所有DNA。在这项研究中,我们努力比较mNGS与常规培养方法在成人脓毒症患者中的结局,调查免疫受损组和对照组之间的差异,并评估mNGS的临床效果。
■在我们的研究中,包括308名成人脓毒症患者。我们使用了mNGS和常规培养方法来分析诊断结果,病原体,和样品类型。还分析了一些实验室检查与各组病原体频率之间的相关性。此外,对mNGS的临床影响进行了估计.
■将308个样品分配到免疫受损组(92/308,29.9%)和对照组(216/308,70.1%)。在所有样品中,mNGS的灵敏度均高于培养方法(88.0%vs26.3%;P<0.001),在免疫受损组(91.3%vs26.1%;P<0.001),对照组(86.6%vs26.4%;P<0.001),特别是在所有类型的血液样本中(P<0.001),BALF(P<0.001),CSF(P<0.001),痰液(P<0.001)和腹水(P=0.008)。当检查组间的mNGS结果时,肺孢子虫(P<0.001),毛果科(P=0.014),与克雷伯菌属(P=0.045)均有显著性差异。总的来说,mNGS检测到的病原体比培养方法多(111vs25),发现了89种通过培养方法在整个样本中不断被忽视的生物,在76.3%(308中的235例)的患者中显示出良好的积极临床效果。在185例(60.1%)患者中,MNGS在管理过程中促使进行了修改,其中包括61例(19.8%)患者的抗生素降级.
■研究发现mNGS比培养方法更灵敏,特别是在血液样本中,BALF,CSF,痰,和腹水。检查mNGS结果时,在免疫功能低下的脓毒症患者中更常见的病原体是jirovecii和Mucoraceae,这需要临床医生的更多关注。mNGS在增强败血症的诊断和推进患者治疗方面具有显著的益处。
Metagenomic next-generation sequencing (mNGS) was commonly applied given its ability to identify and type all infections without depending upon culture and to retrieve all DNA with unbiasedness. In this study, we strive to compare outcomes of mNGS with conventional culture methods in adults with sepsis, investigate the differences between the immunocompromised and control group, and assess the clinical effects of mNGS.
In our study, 308 adult sepsis patients were included. We used both mNGS and conventional culture methods to analyze diagnostic results, pathogens, and sample types. The correlation between some laboratory tests and the frequency of pathogens by groups was also analyzed. Furthermore, the clinical impacts of mNGS were estimated.
308 samples were assigned to an immunocompromised group (92/308,29.9%) and a control group (216/308,70.1%). There was the sensitivity of mNGS considered greater than that of the culture method in all samples (88.0% vs 26.3%; P < 0.001), in the immunocompromised group (91.3% vs 26.1%; P < 0.001), and the control group (86.6% vs 26.4%; P < 0.001), particularly in all sample types of blood (P < 0.001), BALF (P < 0.001), CSF (P < 0.001), sputum (P < 0.001) and ascitic fluid (P = 0.008). When examining the mNGS results between groups, Pneumocystis jirovecii (P < 0.001), Mucoraceae (P = 0.014), and Klebsiella (P = 0.045) all showed significant differences. On the whole, mNGS detected more pathogens than culture methods (111 vs 25), found 89 organisms that were continuously overlooked in entire samples by culture methods, and showed a favorable positive clinical effect in 76.3% (235 of 308) of patients. In 185 (60.1%) patients, mNGS prompted a modification in the course of management, which included antibiotic de-escalation in 61(19.8%) patients.
The research discovered that mNGS was more sensitive than the culture method, particularly in samples of blood, BALF, CSF, sputum, and ascitic fluid. When examining the mNGS results, Pneumocystis jirovecii and Mucoraceae were the pathogens seen more commonly in immunocompromised patients with sepsis, which required more attention from clinicians. There was a substantial benefit of mNGS in enhancing the diagnosis of sepsis and advancing patient treatment.