Metagenomic Next-Generation Sequencing Versus Traditional Laboratory Methods for the Diagnosis and Treatment of Infection in Liver Transplantation.
Metagenomic Next-Generation Sequencing Versus Traditional Laboratory Methods for the Diagnosis and Treatment of Infection in Liver Transplantation.
复制标题
宏基因组新一代测序与传统实验室方法在肝移植感染的诊断和治疗中的比较
DOI：
10.3389/fcimb.2022.886359
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发表时间：
2022
影响因子：
5.7
通讯作者：
中科院分区：
文献类型：
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作者：
背景宏基因组下一代测序（mNGS）已成为一种非侵入性和精确检测感染性病原体的有效方法。然而，缺乏关于mNGS分析是否可用于肝移植（LT）患者围手术期感染的诊断和治疗的数据。方法2018年2月至2018年10月，我们使用mNGS和传统实验室方法（TM），包括培养、血清学检测和核酸检测，对42对尸体肝脏供体及其相应受体进行了病原体检测。比较了mNGS和TM在确定围手术期感染和指导后续临床决策方面的方法性能。结果mNGS阳性率（64.3%，27/42）明显高于TM（28.6%，12/42）（P<0.05）。mNGS法检出供肝者混合感染率为23.8%（10/42），明显高于TM法的0.0%（0/42）（P<0.01）。使用mNGS检测到43种病原体，而使用TM仅鉴定出12种病原体。在种属水平上，mNGS分析结果与91.7%（11/12）供体样本的TM分析结果一致，而mNGS可用于检测66.7%（20/30）使用TM视为病原体阴性的供体中的病原体。6例供受者mNGS检测出相同病原体，其中4例最终确诊为供者源性感染（DDI）。对于TM，仅在2例病例中检测到相同的病原体。此外，8名受者在LT后出现早期感染症状（<7天）;我们根据mNGS结果调整抗生素类型和/或停用免疫抑制剂。在8例感染患者中，7例受者恢复，1例患者死于严重脓毒症。结论mNGS分析能快速、准确地检测多种LT患者临床标本中的病原体，结合临床感染症状，mNGS分析在DDI的早期识别和辅助临床决策方面具有上级优势。mNGS结果对于LT患者围手术期感染的管理至关重要。
Background Metagenomic next-generation sequencing (mNGS) has emerged as an effective method for the noninvasive and precise detection of infectious pathogens. However, data are lacking on whether mNGS analyses could be used for the diagnosis and treatment of infection during the perioperative period in patients undergoing liver transplantation (LT). Methods From February 2018 to October 2018, we conducted an exploratory study using mNGS and traditional laboratory methods (TMs), including culture, serologic assays, and nucleic acid testing, for pathogen detection in 42 pairs of cadaveric liver donors and their corresponding recipients. Method performance in determining the presence of perioperative infection and guiding subsequent clinical decisions was compared between mNGS and TMs. Results The percentage of liver donors with mNGS-positive pathogen results (64.3%, 27/42) was significantly higher than that using TMs (28.6%, 12/42; P<0.05). The percentage of co-infection detected by mNGS in liver donors was 23.8% (10/42) significantly higher than 0.0% (0/42) by TMs (P<0.01). Forty-three pathogens were detected using mNGS, while only 12 pathogens were identified using TMs. The results of the mNGS analyses were consistent with results of the TM analyses in 91.7% (11/12) of donor samples at the species level, while mNGS could be used to detect pathogens in 66.7% (20/30) of donors deemed pathogen-negative using TMs. Identical pathogens were detected in 6 cases of donors and recipients by mNGS, among which 4 cases were finally confirmed as donor-derived infections (DDIs). For TMs, identical pathogens were detected in only 2 cases. Furthermore, 8 recipients developed early symptoms of infection (<7 days) after LT; we adjusted the type of antibiotics and/or discontinued immunosuppressants according to the mNGS results. Of the 8 patients with infections, 7 recipients recovered, and 1 patient died of severe sepsis. Conclusions Our preliminary results show that mNGS analyses can provide rapid and precise pathogen detection compared with TMs in a variety of clinical samples from patients undergoing LT. Combined with symptoms of clinical infection, mNGS showed superior advantages over TMs for the early identification and assistance in clinical decision-making for DDIs. mNGS results were critical for the management of perioperative infection in patients undergoing LT.
影响因子：
3.7
作者：
da Silva FR;Cibulski SP;Daudt C;Weber MN;Guimarães LL;Streck AF;Mayer FQ;Roehe PM;Canal CW
通讯作者：
Canal CW