UNASSIGNED:与传统诊断方法(TDM)相比,迫切需要传染病(ID)的快速诊断方法。宏基因组下一代测序(mNGS)已成为一种有前途的临床感染诊断技术。
UNASSIGNED:这项回顾性观察性研究于2019年5月至2022年8月在中国一家三级医院进行。用卡方检验比较mNGS和TDM的敏感性和特异性。我们还对不同病原体和样品进行了亚组分析。
UNASSIGNED:共纳入435例临床怀疑感染的患者,最后将372例(85.5%)患者归入ID组。mNGS的总体敏感性明显高于TDM(59.7%vs.30.1%,P<0.05)。然而,两种方法的总体特异性无显著差异(83.3%vs.89.6%,P=0.37)。在确定有病原体的患者中,mNGS检测细菌的阳性率(88.7%),真菌(87.9%),病毒(96.9%),非结核分枝杆菌(NTM;100%)明显高于TDM(P<0.05)。mNGS检测结核分枝杆菌的阳性率并不优于TDMs(77.3%vs.54.5%,P=0.11)。mNGS对支气管肺泡灌洗液中病原体鉴定的敏感性,血,脑脊液,胸腔积液,组织为72.6%,39.3%,37.5%,35.0%和80.0%,分别。
未经证实:具有筛选多种临床样本的潜力,mNGS相对于TDMs具有整体优势,能有效识别病原菌,特别是那些使用TDM很难识别的,例如NTM,衣原体,和寄生虫。
Compared with traditional diagnostic methods (TDMs), rapid diagnostic methods for infectious diseases (IDs) are urgently needed. Metagenomic next-generation sequencing (mNGS) has emerged as a promising diagnostic technology for clinical infections.
This retrospective observational study was performed at a tertiary hospital in China between May 2019 and August 2022. The chi-square test was used to compare the sensitivity and specificity of mNGS and TDMs. We also performed a subgroup analysis of the different pathogens and samples.
A total of 435 patients with clinical suspicion of infection were enrolled and 372 (85.5%) patients were finally categorized as the ID group. The overall sensitivity of mNGS was significantly higher than that of the TDMs (59.7% vs. 30.1%, P < 0.05). However, there was no significant difference in the overall specificity between the two methods (83.3% vs. 89.6%, P = 0.37). In patients with identified pathogens, the positive rates of mNGS for detecting bacteria (88.7%), fungi (87.9%), viruses (96.9%), and Nontuberculous mycobacteria (NTM; 100%) were significantly higher than those of TDMs (P < 0.05). The positive rate of mNGS for detecting Mycobacterium tuberculosis was not superior to that of TDMs (77.3% vs. 54.5%, P = 0.11). The sensitivity rates of mNGS for pathogen identification in bronchoalveolar lavage fluid, blood, cerebrospinal fluid, pleural fluid, and tissue were 72.6%, 39.3%, 37.5%, 35.0% and 80.0%, respectively.
With the potential for screening multiple clinical samples, mNGS has an overall advantage over TDMs. It can effectively identify pathogens, especially those that are difficult to identify using TDMs, such as NTM, chlamydia, and parasites.