■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。
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.