Clinical application and evaluation of metagenomic next-generation sequencing in suspected adult central nervous system infection
Clinical application and evaluation of metagenomic next-generation sequencing in suspected adult central nervous system infection
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DOI：
10.1186/s12967-020-02360-6
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发表时间：
2020-05-13
影响因子：
7.4
通讯作者：
Zhang, Wen-Hong
中科院分区：
文献类型：
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作者：
Zhang, Yi;Cui, Peng;Zhang, Wen-Hong
背景准确的病原学诊断对中枢神经系统感染(CNS感染)至关重要。元基因组下一代测序(MNGS)是一个新兴的强大平台，其在中枢神经系统感染中的诊断价值仍有待研究。方法采用单中心前瞻性队列研究方法，对248例疑似中枢神经系统感染患者与常规培养、涂片等方法进行比较，记录临床资料。结果MNGS在未经经验性治疗的培养阳性患者中的敏感度为90.00%(9/10)，在经验性治疗的患者中为66.67%(6/9)。在培养阴性的患者中检测到额外的48种细菌和真菌，MNGS提供了比培养(34.45%比7.56%，麦克内玛检验，p<；0.0083)或没有经验治疗的患者(50.00%比25.00%，麦克内玛测试，p>；0.0083)更高的检测率。与常规方法比较，阳性符合率为75.00%，阴性符合率为69.11%。脑脊液WBC>；300×10(6)/L、脑脊液蛋白质>；500 mg/L或葡萄糖比值的患者MNGS的检出率显著高于对照组
Background Accurate etiology diagnosis is crucial for central nervous system infections (CNS infections). The diagnostic value of metagenomic next-generation sequencing (mNGS), an emerging powerful platform, remains to be studied in CNS infections. Methods We conducted a single-center prospective cohort study to compare mNGS with conventional methods including culture, smear and etc. 248 suspected CNS infectious patients were enrolled and clinical data were recorded. Results mNGS reported a 90.00% (9/10) sensitivity in culture-positive patients without empirical treatment and 66.67% (6/9) in empirically-treated patients. Detected an extra of 48 bacteria and fungi in culture-negative patients, mNGS provided a higher detection rate compared to culture in patients with (34.45% vs. 7.56%, McNemar test, p < 0.0083) or without empirical therapy (50.00% vs. 25.00%, McNemar test, p > 0.0083). Compared to conventional methods, positive percent agreement and negative percent agreement was 75.00% and 69.11% separately. mNGS detection rate was significantly higher in patients with cerebrospinal fluid (CSF) WBC > 300 * 10(6)/L, CSF protein > 500 mg/L or glucose ratio