■宏基因组下一代测序(mNGS)技术已广泛用于诊断各种感染。根据最常见的病原体概况,已开发出使用多重PCR的靶向mNGS(tNGS),以使用面板中预先设计的引物检测病原体,显著提高敏感性,减轻患者经济负担。然而,在中国吉林省,很少有大规模总结免疫功能正常和免疫功能低下患者肺部感染的病原体谱的研究。
■从2021年1月至2023年12月,收集了546名免疫活性和免疫功能低下的疑似社区获得性肺炎患者的支气管肺泡灌洗液(BALF)或痰液样本。总结了进行mNGS的患者的病原体谱。此外,我们还评估了tNGS在肺部感染诊断中的表现.
■结合mNGS和培养的结果,我们发现最常见的细菌病原体是铜绿假单胞菌,肺炎克雷伯菌,在免疫功能低下和免疫功能正常的患者中,鲍曼不动杆菌对金黄色葡萄球菌和屎肠球菌的检出率较高,分别。对于真菌病原体,肺孢子虫在患者中常见,而免疫功能正常患者的真菌感染主要由白色念珠菌引起。患者的大多数病毒感染是由人β疱疹病毒5和人γ疱疹病毒4引起的。值得注意的是,与免疫功能正常的患者相比(34.9%,76/218),在免疫功能低下的患者中发现了更多的混合感染(37.8%,14/37).此外,以最终综合临床诊断为参考标准,BALFtNGS的总符合率(81.4%,48/59)远高于BALFmNGS(40.0%,112/280)。
■我们的发现补充并分类了中国吉林省有免疫能力和免疫功能低下患者肺部感染的病原体谱。最重要的是,我们的发现可以加速专门用于区域性肺部感染的tNGS的开发和设计.
UNASSIGNED: Metagenomic next-generation sequencing (mNGS) technology has been widely used to diagnose various infections. Based on the most common pathogen profiles, targeted mNGS (tNGS) using multiplex PCR has been developed to detect pathogens with predesigned primers in the panel, significantly improving sensitivity and reducing economic burden on patients. However, there are few studies on summarizing pathogen profiles of pulmonary infections in immunocompetent and immunocompromised patients in Jilin Province of China on large scale.
UNASSIGNED: From January 2021 to December 2023, bronchoalveolar lavage fluid (BALF) or sputum samples from 546 immunocompetent and immunocompromised patients with suspected community-acquired pneumonia were collected. Pathogen profiles in those patients on whom mNGS was performed were summarized. Additionally, we also evaluated the performance of tNGS in diagnosing pulmonary infections.
UNASSIGNED: Combined with results of mNGS and culture, we found that the most common bacterial pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii in both immunocompromised and immunocompetent patients with high detection rates of Staphylococcus aureus and Enterococcus faecium, respectively. For fungal pathogens, Pneumocystis jirovecii was commonly detected in patients, while fungal infections in immunocompetent patients were mainly caused by Candida albicans. Most of viral infections in patients were caused by Human betaherpesvirus 5 and Human gammaherpesvirus 4. It is worth noting that, compared with immunocompetent patients (34.9%, 76/218), more mixed infections were found in immunocompromised patients (37.8%, 14/37). Additionally, taking final comprehensive clinical diagnoses as reference standard, total coincidence rate of BALF tNGS (81.4%, 48/59) was much higher than that of BALF mNGS (40.0%, 112/280).
UNASSIGNED: Our findings supplemented and classified the pathogen profiles of pulmonary infections in immunocompetent and immunocompromised patients in Jilin Province of China. Most importantly, our findings can accelerate the development and design of tNGS specifically used for regional pulmonary infections.