宏基因组下一代测序(mNGS)在成人感染性疾病的诊断中显示出希望,而其在儿科感染中的疗效仍不确定。我们对来自儿科患者的1,493mNGS样本进行了回顾性分析,中枢神经系统,和下呼吸道感染.基于临床诊断,将mNGS的阳性百分比一致性(PPA)和阴性百分比一致性(NPA)与常规微生物测试(CMT)进行了比较。与CMT相比,mNGS的协议,以及MNGS的临床影响,被估值。以临床诊断为参考,与CMT相比,mNGS显示出明显更高的总体PPA(53.1%[95%CI=49.7至56.6%]与25.8%[95%CI=22.8至28.9%]),同时保持相当的总体NPA(93.2%[95%CI=91.3至95.1%]与97.2%[95%CI=95.9至98.4%])。在6岁以下或具有免疫抑制状态的脓毒症患者中,与CMT相比,mNGS显示出更高的PPA和相当的NPA。与CMT相比,mNGS的总PPA和NPA分别为75.3%和75.0%,分别。大多数肺炎链球菌病例,无乳链球菌,结核分枝杆菌复合体,和jirovecii肺孢子虫感染通过mNGS鉴定。积极的临床影响为14.0%(206/1,473),负面影响为0.8%(11/1,473),无影响84.7%(1,248/1,473),在mNGS结果中观察到0.5%(8/1,473)的未知影响。值得注意的是,免疫抑制患者的积极影响大于非免疫抑制患者(67/247,27.1%vs139/1,226,11.3%;P<0.001).mNGS对病原体检测很有价值,诊断,以及儿科患者感染的临床管理。因此,mNGS对儿科感染的诊断是有效的,可以指导临床管理。患有免疫抑制疾病的患者从mNGS测试中受益更多。
Metagenomic next-generation sequencing (mNGS) has shown promise in the diagnosis of infectious diseases in adults, while its efficacy in pediatric infections remains uncertain. We performed a retrospective analysis of 1,493 mNGS samples from pediatric patients with blood, central nervous system, and lower respiratory tract infections. The positive percent agreement (PPA) and the negative percent agreement (NPA) of mNGS were compared to conventional microbiological tests (CMT) based on clinical diagnosis. The agreement of mNGS compared to CMT, as well as the clinical impact of mNGS, were valuated. Using the clinical diagnosis as a reference, mNGS demonstrated a significantly higher overall PPA compared to CMT (53.1% [95% CI = 49.7 to 56.6%] versus 25.8% [95% CI = 22.8 to 28.9%]), while maintaining a comparable overall NPA (93.2% [95% CI = 91.3 to 95.1%] versus 97.2% [95% CI = 95.9 to 98.4%]). In septic patients under 6 years of age or with immunosuppressive status, mNGS showed a higher PPA and a comparable NPA compared to CMT. The overall PPA and NPA of mNGS compared to CMT were 75.3 and 75.0%, respectively. The majority of cases of Streptococcus pneumoniae, Streptococcus agalactiae, Mycobacterium tuberculosis complex, and Pneumocystis jirovecii infections were identified by mNGS. A positive clinical impact of 14.0% (206/1,473), a negative impact of 0.8% (11/1,473), a nonimpact of 84.7% (1,248/1,473), and an unknown impact of 0.5% (8/1,473) were observed in the mNGS results. Notably, the positive impact was greater among immunosuppressed patients than among nonimmunosuppressed individuals (67/247, 27.1% versus 139/1,226, 11.3%; P < 0.001). mNGS is valuable for pathogen detection, diagnosis, and clinical management of infections among pediatric patients. mNGS was thus effective for the diagnosis of pediatric infections, which may guide clinical management. Patients with immunosuppressive conditions benefited more from mNGS testing.