■感染是异基因造血干细胞移植(HSCT)后患者死亡的主要原因。然而,由于其由地理区域引起的异质性,病原体谱仍未详细报道。
■评估宏基因组下一代测序(mNGS)的性能,并总结HSCT后感染患者的区域性病原体谱。
■从2021年2月到2022年8月,64名患者,入住吉林大学第一医院血液科进行HSCT,诊断为疑似感染,进行回顾性登记。
■共有38名患者被诊断为感染,包括血液(n=17),肺(n=16),中枢神经系统(CNS)(n=4),和胸部(n=1)感染。人β-疱疹病毒5型(CMV)是血液(n=10)和肺部(n=8)感染中最常见的病原体,而中枢神经系统(n=2)和胸部(n=1)感染主要由人γ疱疹病毒4(EBV)引起。对于血流感染,结核分枝杆菌复合体(n=3),表皮葡萄球菌(n=1),和热带念珠菌(n=1)也被诊断为病原体。此外,mNGS结合常规检测可以识别更多的病原体,灵敏度高达82.9%(95%CI70.4-95.3%),总符合率可达76.7%(95%CI64.1-89.4%)。
■我们的发现强调了mNGS在诊断中的重要性,管理,排除感染,一个更快速的时代,独立,并且可以预期HSCT后感染的公正诊断。
UNASSIGNED: Infection is the main cause of death for patients after allogeneic hematopoietic stem cell transplantation (HSCT). However, pathogen profiles still have not been reported in detail due to their heterogeneity caused by geographic region.
UNASSIGNED: To evaluate the performance of metagenomic next-generation sequencing (mNGS) and summarize regional pathogen profiles of infected patients after HSCT.
UNASSIGNED: From February 2021 to August 2022, 64 patients, admitted to the Department of Hematology of The First Hospital of Jilin University for HSCT and diagnosed as suspected infections, were retrospectively enrolled.
UNASSIGNED: A total of 38 patients were diagnosed as having infections, including bloodstream (n =17), pulmonary (n =16), central nervous system (CNS) (n =4), and chest (n =1) infections. Human betaherpesvirus 5 (CMV) was the most common pathogen in both bloodstream (n =10) and pulmonary (n =8) infections, while CNS (n =2) and chest (n =1) infections were mainly caused by Human gammaherpesvirus 4 (EBV). For bloodstream infection, Mycobacterium tuberculosis complex (n =3), Staphylococcus epidermidis (n =1), and Candida tropicalis (n =1) were also diagnosed as causative pathogens. Furthermore, mNGS combined with conventional tests can identify more causative pathogens with high sensitivity of 82.9% (95% CI 70.4-95.3%), and the total coincidence rate can reach up to 76.7% (95% CI 64.1-89.4%).
UNASSIGNED: Our findings emphasized the importance of mNGS in diagnosing, managing, and ruling out infections, and an era of more rapid, independent, and impartial diagnosis of infections after HSCT can be expected.