Targeted next-generation sequencing for pulmonary infection diagnosis in patients unsuitable for bronchoalveolar lavage.
Targeted next-generation sequencing for pulmonary infection diagnosis in patients unsuitable for bronchoalveolar lavage.
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DOI：
10.3389/fmed.2023.1321515
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发表时间：
2023
影响因子：
3.9
通讯作者：
Wang, Yuanli
中科院分区：
文献类型：
--
作者：
Deng, Zhenfeng;Li, Chunhong;Wang, Yingjin;Wu, Fengwen;Liang, Chunfang;Deng, Wei;Wang, Yuanli
关键词：
靶向下一代测序（tNGS）已成为一种快速诊断技术，用于识别导致肺部感染的广泛病原体。从不能或不愿接受支气管肺泡灌洗的患者中采集痰液样本。对这些样本进行tNGS分析以诊断肺部感染。对临床数据进行回顾性分析，并将tNGS的临床疗效与传统微生物检测（CMT）进行比较。本研究纳入了209例确诊肺部感染的儿童和成人患者。tNGS检测到45种潜在病原体，而CMT确定了23种病原体。tNGS和CMT之间的总体微生物检出率显著不同（96.7% vs. 36.8%，p < 0.001）。在tNGS和CMT结果一致的76例患者中，86.8%（66/76）显示完全或部分一致。对于高致病性和罕见/非定殖微生物，tNGS结合全面的临床回顾，直接指导了21例患者的病原学诊断和抗生素治疗。这包括由结核分枝杆菌复合体、某些非典型病原体、曲霉菌和非结核分枝杆菌引起的感染。在入组人群中，38.8%（81/209）的患者根据tNGS结果调整了治疗。此外，tNGS研究结果揭示了儿童和成人之间病原体分布的年龄特异性异质性。CMT通常不能满足肺部感染的诊断需求。这项研究强调了来自不能或不愿接受支气管肺泡灌洗的患者的痰液样本的tNGS如何对潜在病原体产生有价值的见解，从而增强了特定病例中肺部感染的诊断。
Targeted next-generation sequencing (tNGS) has emerged as a rapid diagnostic technology for identifying a wide spectrum of pathogens responsible for pulmonary infections. Sputum samples were collected from patients unable or unwilling to undergo bronchoalveolar lavage. These samples underwent tNGS analysis to diagnose pulmonary infections. Retrospective analysis was performed on clinical data, and the clinical efficacy of tNGS was compared to conventional microbiological tests (CMTs). This study included 209 pediatric and adult patients with confirmed pulmonary infections. tNGS detected 45 potential pathogens, whereas CMTs identified 23 pathogens. The overall microbial detection rate significantly differed between tNGS and CMTs (96.7% vs. 36.8%, p < 0.001). Among the 76 patients with concordant positive results from tNGS and CMTs, 86.8% (66/76) exhibited full or partial agreement. For highly pathogenic and rare/noncolonized microorganisms, tNGS, combined with comprehensive clinical review, directly guided pathogenic diagnosis and antibiotic treatment in 21 patients. This included infections caused by Mycobacterium tuberculosis complex, certain atypical pathogens, Aspergillus, and nontuberculous Mycobacteria. Among the enrolled population, 38.8% (81/209) of patients adjusted their treatment based on tNGS results. Furthermore, tNGS findings unveiled age-specific heterogeneity in pathogen distribution between children and adults. CMTs often fall short in meeting the diagnostic needs of pulmonary infections. This study highlights how tNGS of sputum samples from patients who cannot or will not undergo bronchoalveolar lavage yield valuable insights into potential pathogens, thereby enhancing the diagnosis of pulmonary infections in specific cases.
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DOI：
10.1016/j.cmi.2021.05.034
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期刊：
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影响因子：
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通讯作者：
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