Incremental value of metagenomic next generation sequencing for the diagnosis of suspected focal infection in adults
Incremental value of metagenomic next generation sequencing for the diagnosis of suspected focal infection in adults
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DOI：
10.1016/j.jinf.2019.08.012
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发表时间：
2019-11-01
影响因子：
28.2
通讯作者：
Zhang, Wen-Hong
中科院分区：
文献类型：
--
作者：
Zhang, Hao-Cheng;Ai, Jing-Wen;Zhang, Wen-Hong
目的：微生物学诊断在临床治疗局灶性感染中至关重要。宏基因组下一代测序（mNGS）已被报道为感染性疾病的有前途的诊断工具。然而，关于mNGS在局灶性感染中的临床效用知之甚少。我们进行了一项单中心回顾性研究，以探讨mNGS对局灶性感染诊断的影响，并与常规方法（包括培养、病理检查、Xpert MTB/RIF等）进行比较，纳入了98例疑似局灶性感染病例，并回顾了病历，以确定其检出率、识别时间，结果：mNGS诊断符合率为86.30%（95% CI：75.79-92.88%），相比之下，培养法检出率为33.68-57.24%，常规法检出率为57.53%（95% CI：45.43-68.84%）（p < 0.0125），多检出34种病原微生物。使用mNGS进行病原体鉴定的时间要求为31 h至55 h，这显示出比培养的优势。（82.36 h; 95%可信区间：结论：mNGS在局灶性感染的病原学诊断中具有很好的应用前景，可帮助临床医生做出更及时、更有针对性的治疗决策。(C)2019年英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: Microbiological diagnosis is essential during clinical management of focal infections. Metagenomic next generation sequencing (mNGS) has been reported as a promising diagnostic tool in infectious diseases. However, little is known about the clinical utility of mNGS in focal infections.Methods: We conducted a single-center retrospective study to investigate impact of mNGS on focal infection diagnosis and compared it with conventional methods, including culture, pathological examination, Xpert MTB/RIF, etc. 98 suspected focal infections cases were enrolled, and medical records were reviewed to determine their rates of detection, time-to-identification, and clinical outcomes.Results: mNGS showed a satisfying diagnostic positive percent agreement of 86.30% (95% CI: 75.79-92.88%) in a variety of tissues, compared to 45.21% (95% CI: 33.68-57.24%) for culture and 57.53% (95% CI: 45.43-68.84%)f for conventional methods (p < 0.0125), and detected an extra 34 pathogenic microorganisms. Time requirement for pathogen identification using mNGS ranges from 31 h to 55 h, which showed an advantage over culture. (82.36 h; 95%CI: 65.83, 98.89; P < 0.05)Conclusions: mNGS showed promising potential in pathogenic diagnosis during focal infections and might enable clinicians to make more timely and targeted therapeutic decisions. (C) 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.