The clinical application of metagenomic next-generation sequencing in sepsis of immunocompromised patients
BackgroundMetagenomic next-generation sequencing (mNGS) was commonly applied given its ability to identify and type all infections without depending upon culture and to retrieve all DNA with unbiasedness. In this study, we strive to compare outcomes of mNGS with conventional culture methods in adult...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Cellular and Infection Microbiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcimb.2023.1170687/full |
| _version_ | 1827960928750010368 |
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| author | Xingxing Li Shunda Liang Dan Zhang Miao He Hong Zhang |
| author_facet | Xingxing Li Shunda Liang Dan Zhang Miao He Hong Zhang |
| author_sort | Xingxing Li |
| collection | DOAJ |
| description | BackgroundMetagenomic next-generation sequencing (mNGS) was commonly applied given its ability to identify and type all infections without depending upon culture and to retrieve all DNA with unbiasedness. In this study, we strive to compare outcomes of mNGS with conventional culture methods in adults with sepsis, investigate the differences between the immunocompromised and control group, and assess the clinical effects of mNGS.MethodsIn our study, 308 adult sepsis patients were included. We used both mNGS and conventional culture methods to analyze diagnostic results, pathogens, and sample types. The correlation between some laboratory tests and the frequency of pathogens by groups was also analyzed. Furthermore, the clinical impacts of mNGS were estimated.Results308 samples were assigned to an immunocompromised group (92/308,29.9%) and a control group (216/308,70.1%). There was the sensitivity of mNGS considered greater than that of the culture method in all samples (88.0% vs 26.3%; P < 0.001), in the immunocompromised group (91.3% vs 26.1%; P < 0.001), and the control group (86.6% vs 26.4%; P < 0.001), particularly in all sample types of blood (P < 0.001), BALF (P < 0.001), CSF (P < 0.001), sputum (P < 0.001) and ascitic fluid (P = 0.008). When examining the mNGS results between groups, Pneumocystis jirovecii (P < 0.001), Mucoraceae (P = 0.014), and Klebsiella (P = 0.045) all showed significant differences. On the whole, mNGS detected more pathogens than culture methods (111 vs 25), found 89 organisms that were continuously overlooked in entire samples by culture methods, and showed a favorable positive clinical effect in 76.3% (235 of 308) of patients. In 185 (60.1%) patients, mNGS prompted a modification in the course of management, which included antibiotic de-escalation in 61(19.8%) patients.ConclusionsThe research discovered that mNGS was more sensitive than the culture method, particularly in samples of blood, BALF, CSF, sputum, and ascitic fluid. When examining the mNGS results, Pneumocystis jirovecii and Mucoraceae were the pathogens seen more commonly in immunocompromised patients with sepsis, which required more attention from clinicians. There was a substantial benefit of mNGS in enhancing the diagnosis of sepsis and advancing patient treatment. |
| first_indexed | 2024-04-09T16:17:37Z |
| format | Article |
| id | doaj.art-eccd73293e1247cfbc1c3e3bdab64fab |
| institution | Directory Open Access Journal |
| issn | 2235-2988 |
| language | English |
| last_indexed | 2024-04-09T16:17:37Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cellular and Infection Microbiology |
| spelling | doaj.art-eccd73293e1247cfbc1c3e3bdab64fab2023-04-24T04:28:21ZengFrontiers Media S.A.Frontiers in Cellular and Infection Microbiology2235-29882023-04-011310.3389/fcimb.2023.11706871170687The clinical application of metagenomic next-generation sequencing in sepsis of immunocompromised patientsXingxing LiShunda LiangDan ZhangMiao HeHong ZhangBackgroundMetagenomic next-generation sequencing (mNGS) was commonly applied given its ability to identify and type all infections without depending upon culture and to retrieve all DNA with unbiasedness. In this study, we strive to compare outcomes of mNGS with conventional culture methods in adults with sepsis, investigate the differences between the immunocompromised and control group, and assess the clinical effects of mNGS.MethodsIn our study, 308 adult sepsis patients were included. We used both mNGS and conventional culture methods to analyze diagnostic results, pathogens, and sample types. The correlation between some laboratory tests and the frequency of pathogens by groups was also analyzed. Furthermore, the clinical impacts of mNGS were estimated.Results308 samples were assigned to an immunocompromised group (92/308,29.9%) and a control group (216/308,70.1%). There was the sensitivity of mNGS considered greater than that of the culture method in all samples (88.0% vs 26.3%; P < 0.001), in the immunocompromised group (91.3% vs 26.1%; P < 0.001), and the control group (86.6% vs 26.4%; P < 0.001), particularly in all sample types of blood (P < 0.001), BALF (P < 0.001), CSF (P < 0.001), sputum (P < 0.001) and ascitic fluid (P = 0.008). When examining the mNGS results between groups, Pneumocystis jirovecii (P < 0.001), Mucoraceae (P = 0.014), and Klebsiella (P = 0.045) all showed significant differences. On the whole, mNGS detected more pathogens than culture methods (111 vs 25), found 89 organisms that were continuously overlooked in entire samples by culture methods, and showed a favorable positive clinical effect in 76.3% (235 of 308) of patients. In 185 (60.1%) patients, mNGS prompted a modification in the course of management, which included antibiotic de-escalation in 61(19.8%) patients.ConclusionsThe research discovered that mNGS was more sensitive than the culture method, particularly in samples of blood, BALF, CSF, sputum, and ascitic fluid. When examining the mNGS results, Pneumocystis jirovecii and Mucoraceae were the pathogens seen more commonly in immunocompromised patients with sepsis, which required more attention from clinicians. There was a substantial benefit of mNGS in enhancing the diagnosis of sepsis and advancing patient treatment.https://www.frontiersin.org/articles/10.3389/fcimb.2023.1170687/fullmetagenomic next-generation sequencingsepsisimmunocompromised patientsdiagnosticsensitivityclinical effect |
| spellingShingle | Xingxing Li Shunda Liang Dan Zhang Miao He Hong Zhang The clinical application of metagenomic next-generation sequencing in sepsis of immunocompromised patients Frontiers in Cellular and Infection Microbiology metagenomic next-generation sequencing sepsis immunocompromised patients diagnostic sensitivity clinical effect |
| title | The clinical application of metagenomic next-generation sequencing in sepsis of immunocompromised patients |
| title_full | The clinical application of metagenomic next-generation sequencing in sepsis of immunocompromised patients |
| title_fullStr | The clinical application of metagenomic next-generation sequencing in sepsis of immunocompromised patients |
| title_full_unstemmed | The clinical application of metagenomic next-generation sequencing in sepsis of immunocompromised patients |
| title_short | The clinical application of metagenomic next-generation sequencing in sepsis of immunocompromised patients |
| title_sort | clinical application of metagenomic next generation sequencing in sepsis of immunocompromised patients |
| topic | metagenomic next-generation sequencing sepsis immunocompromised patients diagnostic sensitivity clinical effect |
| url | https://www.frontiersin.org/articles/10.3389/fcimb.2023.1170687/full |
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