Introduction
Recently, the Laboratory Department of the First Affiliated Hospital of Suzhou University cooperated with Difei Medical to Infectious Diseases and Therapy (IF=6.119） The magazine published a prospective research article.By conducting mNGS technology testing and conventional traditional testing (Conventional tests) on 201 patients suspected of having acute or chronic infections,CTs), collect patients’ clinical treatment plans to Explore the clinical application value of mNGS technology in pathogen diagnosis and treatment decision-making .As a co-author, Diffei Medical participated in the data analysis and article writing of this study. / Research Background /
Rapid and widespread detection of infectious disease pathogens is critical for clinical diagnosis and timely treatment, especially in severely ill patients.We investigated the value of metagenomic next-generation sequencing (mNGS) in real-world clinical settings in a large cohort with diversity of pathogens and sample types.
/Research Highlights/
Compared with CTs detection results,The detection sensitivity of mNGS technology is 98.8%, the specificity is 38.5%, and the accuracy is 87.1%;
Among the 41 patients with follow-up information, 24 patients adjusted their clinical treatment plans based on mNGS results.The clinical symptoms of more than 70% (17/24) patients were significantly improved。
/ Research result /
A total of 228 samples from 215 patients were prospectively collected, including 34 peripheral blood, 147 sputum, and 47 alveolar lavage fluid.Among them, 27 patients had two or more samples.Finally, 201 samples from 188 patients passed the QC process of mNGS testing and were included in subsequent analysis.Among all samples, 42.6% had lower respiratory tract infections, 7 samples had bloodstream infections, and the other samples had infections of unknown origin.
figure 1 Metagenomic analysis of clinical samples and quality control data
2. mNGS performance analysis
Compared with CTs results, the overall sensitivity of mNGS in all samples was 98.8%, of which the sensitivity of blood samples was 100%, the sensitivity of BALF samples was 96.6%, and the sensitivity of sputum samples was 99.2%.The overall specificity was 38.5% and the accuracy was 87.1%.In terms of test results, 79.6% (160/201) of the samples had positive mNGS and CTs results, and 7.5% (15/201) of the samples had double negative results.Among the double-positive samples, 109 cases had consistent mNGS and CTs results, of which 77 cases were consistent at the species level and 32 cases were consistent at the genus level.In addition, the results of the two samples were partially consistent in 25 cases, and the test results of the remaining 26 samples were inconsistent.
Compared with traditional microbial detection technology, mNGS has significant advantages in pathogen detection rate, and especially plays an important role in determining the cause of infectious diseases. It can provide clinicians with auxiliary antibiotic treatment decisions, thereby improving treatment effects.Therefore, in clinical practice, mNGS technology can be used as a powerful complementary means for pathogen detection and treatment decision-making. When analyzing the composition of pathogenic microorganisms in 109 samples with consistent mNGS and CTs results, it was found that most of them were infected by a single pathogen, of which 38.5% were Gram-negative bacteria, 20.2% were Gram-positive bacteria, and 10.1% were tuberculosis. Mycobacteria.And 24.8% of the samples were infected by multiple pathogens, of which 20.2% were infected by multiple bacteria, 3.7% were co-infected by bacteria and fungi, and 0.9% were co-infected by fungi and viruses.Only 1.8% of samples had viral infections and 4.6% had fungal infections.
Figure 2 Validation of mNGS detection and performance analysis
3. Species composition analysis
After analyzing the pathogenic microorganisms of the positive samples, it was found that compared with CTS, the bacteria and viruses in the mNGS results were statistically significantly different.At the same time, CTS can identify more fungi.For some pathogens, mNGS can identify species level, while CTs can only identify pathogens at the genus level, such as Neisseria and Candida.In addition, 14 bacterial species, 2 fungal species, and 4 viral species were detected only by mNGS.
Figure 3 Comparison of pathogenic microorganisms detected by mNGS and CTs
4. Application of mNGS results in clinical diagnosis and treatment decisions
For samples with inconsistent mNGS and CTs results, a total of 41 patients' follow-up medication information was collected.According to the mNGS test results, 58.5% (24/41) of the patients had their clinical treatment plans adjusted, of which 10 patients only had mNGS results.Specifically, 16 patients received corresponding antibiotic treatment based on Klebsiella pneumoniae, Pseudomonas aeruginosa or Legionella pneumophila detected by mNGS, and 3 patients received oseltamivir and ganciclovir. Antiviral treatment.In addition, 5 patients received antifungal treatment based on Cryptococcus neoformans, Pneumocystis jiroveci, or Candida glabrata detected by mNGS.In the end, more than 70% (17/24) of the patients experienced significant improvement in symptoms under the guidance of mNGS results.
Figure 4 Application of mNGS results in clinical diagnosis and treatment decisions
/ Summarize /
Compared with traditional microbial detection technology, mNGS has significant advantages in pathogen detection rate, and especially plays an important role in determining the cause of infectious diseases. It can provide clinicians with auxiliary antibiotic treatment decisions, thereby improving treatment effects.Therefore, in clinical practice, mNGS technology can be used as a powerful complementary means for pathogen detection and treatment decision-making.
references:
Xu J, Zhou P, Liu J, et al. Utilizing Metagenomic Next-Generation Sequencing (mNGS) for Rapid Pathogen Identification and to Inform Clinical Decision-Making: Results from a Large Real-World Cohort. Infect Dis Ther. 2023;10.1007/ s40121-023-00790-5.
Compiled by: Xueleng Yixi Review: Good Typesetting: Ah Xin