Plasma Microbial Cell-Free DNA Sequencing Technology for the Diagnosis of Sepsis in the ICU.
Plasma Microbial Cell-Free DNA Sequencing Technology for the Diagnosis of Sepsis in the ICU.
复制标题
DOI：
10.3389/fmolb.2021.659390
复制
发表时间：
2021
影响因子：
5
通讯作者：
Wu W
中科院分区：
文献类型：
--
作者：
Wang L;Guo W;Shen H;Guo J;Wen D;Yu Y;Wu W
脓毒症是重症监护病房(ICU)中一种常见的危及生命的疾病，通常在没有病原体识别的情况下进行经验性治疗。作为一种非侵入性的高通量技术，血浆微生物无细胞DNA(McfDNA)测序可以检测未知的病原体，而不依赖于先前的临床或实验室信息。本研究收集了2020年1月至2020年6月疑似血液感染(BSI)患者199例，同时进行血培养和血浆mcfDNA测序，以检测潜在病原体。其他临床微生物检测在血浆mcfDNA测序后7天内进行，包括涂片、从相关感染部位采集的样本培养和β-D-葡聚糖/半乳甘露聚糖(BDG/GM)测试等。诊断为败血症94例(47.2%)，非脓毒症87例(43.7%)，非感染性疾病18例(9.0%)。血浆mcfDNA测序诊断脓毒症的敏感性和特异性分别为68.1%和63.2%，明显优于血培养，尤其是对引起医院感染的常见细菌鲍曼不动杆菌(p<；0.01)和肺炎克雷伯菌(p<；0.01)，以及DNA病毒(仅血浆mcfDNA测序，p<；0.01)。然而，在未接触抗生素的病例中，血浆mcfDNA测序与血培养的阳性率无显著差异(43.6%vs.30.9%，p=0.17)。在非脓毒症组中，44.8%(13/29)的病例仅通过血浆mcfDNA测序发现其他部位感染，如下呼吸道感染(LRI)、腹内感染(IAI)和中枢神经系统感染(CNSI)。对于一些常见病原菌(不包括厌氧菌)，周转时间(TAT)3(从开始核酸提取血样处理到完成测序分析)长于TAT1(从Virtuo的血培养瓶到Off Virtuo)。随着疾病的进展，血浆mcfDNA测序可以清楚地检测到微生物种类的显著动态变化。
Sepsis is a common life-threatening disease in the intensive care unit (ICU) that is usually treated empirically without pathogen identification. As a non-invasive and high-throughput technology, plasma microbial cell-free DNA (mcfDNA) sequencing can detect unknown pathogens independent of previous clinical or laboratory information. In this study, a total of 199 cases suspected of bloodstream infection (BSI) from January 2020 to June 2020 were collected, and potential pathogens were detected by simultaneous blood culture and plasma mcfDNA sequencing. Other clinical microbiological assays were performed within 7 days of plasma mcfDNA sequencing, including smear, culture of samples taken from relevant infected sites, and β-D-glucan/galactomannan (BDG/GM) tests, among others. The diagnoses were classified as sepsis [94 (47.2%)], non-sepsis [87 (43.7%)], and non-infectious disease [18 (9.0%)]. The sensitivity and specificity of plasma mcfDNA sequencing for diagnosing sepsis were 68.1 and 63.2%, respectively, which were significantly better than those of blood culture, especially for the common bacteria that cause hospital-acquired infection, namely, Acinetobacter baumannii (p < 0.01) and Klebsiella pneumoniae (p < 0.01), and DNA viruses (plasma mcfDNA sequencing only, p < 0.01). However, there was no significant difference in the rate of positivity between plasma mcfDNA sequencing and blood culture for antibiotic-non-exposed cases (43.6 vs. 30.9%, p = 0.17). In the non-sepsis group, 44.8% of cases (13/29) detected only by plasma mcfDNA sequencing showed infections in other parts of the body, such as lower respiratory infection (LRI), intra-abdominal infection (IAI) and central nervous system infection (CNSI). For some common pathogens (not including anaerobes), turnaround time (TAT) 3 (TAT from the initiation of blood sample processing by nucleic acid extraction to the completion of sequencing analysis) was longer than TAT1 (TAT from blood culture bottles in Virtuo to off Virtuo). With disease progression, significant dynamic changes in microbial species were clearly detected by plasma mcfDNA sequencing.
登录
查看更多内容
影响因子：
5.2
作者：
Wang J;Zeng Y;Wang S;Liu H;Zhang D;Zhang W;Wang Y;Ji H
通讯作者：
Ji H
影响因子：
4.2
作者：
Rossoff, Jenna;Chaudhury, Sonali;Muller, William J.
通讯作者：
Muller, William J.
影响因子：
12.3
作者：
Grumaz S;Stevens P;Grumaz C;Decker SO;Weigand MA;Hofer S;Brenner T;von Haeseler A;Sohn K
通讯作者：
Sohn K
影响因子：
38.9
作者：
Rhodes, Andrew;Evans, Laura E.;Dellinger, R. Phillip
通讯作者：
Dellinger, R. Phillip
影响因子：
11.8
作者：
Rhee, Chanu;Chiotos, Kathleen;Klompas, Michael
通讯作者：
Klompas, Michael