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| Application of metagenome next-generation sequencing in the patients with anergic pulmonary infection after initial treatment |
| SONG Xiaobo SHENG Chunfeng ZHAO Bangfeng▲ |
Department of Respiratory and Critical Care Medicine, the Central Hospital of Songjiang, Shanghai 201600, China
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Abstract Objective To explore the application of metagenome next-generation sequencing (mNGS) in the patients with anergic pulmonary infection after initial treatment. Methods Fifty patients with anergic pulmonary infection after initial treatment admitted to the Department of Respiratory and Critical Care Medicine, the Central Hospital of Songjiang, Shanghai from January 2021 to February 2022 were retrospectively analyzed. Conventional microbial culture of sputum and bronchoalveolar lavage fluid (BALF) were performed, and mNGS of BALF were detected. The distribution of pathogenic microorganisms was observed, and the differences between the traditional detection method and the mNGS detection method in the microbial detection of anergic pulmonary infection after initial treatment were compared. Results Among the 50 patients with anergic pulmonary infection after initial treatment, two cases were positive for sputum culture, four case were positive for BALF culture, and 44 cases were positive for BALF mNGS. The positive rate of microbial detection of BALF mNGS was higher than those of conventional sputum culture and BALF culture, and the differences were statistically significant (P＜0.05). There was no significant difference in the positive rate of microbial detection between conventional sputum culture and BALF culture (P＞0.05). Twenty-seven patients improved after adjusting antibiotics according to the results of mNGS detection. The most common microorganisms detected in mNGS were bacterial infections, mainly Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Conclusion The application of mNGS in the patients with anergic pulmonary infection after initial treatment has a higher positive rate of microbial detection, which can provide a strong reference for clinical adjustment of treatment plan.
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[1] 安东善，史鹏，吴春风，等.无反应性肺炎病因学研究进展[J].中国临床新医学，2019，12（1）：92-96.
[2] Chiu CY，Miller SA. Clinical metagenomics [J]. Nat Rev Genet，2019，20（6）：341-355.
[3] 《中华传染病杂志》编辑委员会.中国宏基因组学第二代测序技术检测感染病原体的临床应用专家共识[J].中华传染病杂志，2020，38（11）：681-689.
[4] 季永华.电子支气管镜治疗肺炎的临床效果分析[J].世界临床医学，2016，10（21）：19.
[5] Duan H，Li X，Mei A，et al. The diagnostic value of metagenomic next-generation sequencing in infectious diseases [J]. BMC Infect Dis，2021，21（1）：62-74.
[6] 中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南（2016年版）[J].中华结核和呼吸杂志，2016， 39（4）：253-279.
[7] 宏基因组学测序技术在中重症感染中的临床应用共识专家组，中国研究型医院学会脓毒症与休克专业委员会，中国微生物学会微生物毒素专业委员会，等.宏基因组学测序技术在中重症感染中的临床应用专家共识（第一版）[J].中华危重病急救医学，2020，32（5）：531-536.
[8] 陆晓旻，朱际平，陈扬，等.基于宏基因组二代测序诊断的鹦鹉热衣原体肺炎的流行病学特征分析[J].中国临床研究，2022，35（1）：1-5.
[9] Schlaberg R，Chiu CY，Miller S，et al. Validation of Metagenomic Next-Generation Sequencing Tests for Universal Pathogen Detection [J]. Arch Pathol Lab Med，2017，141（6）：776-786.
[10] Ren D，Ren C，Yao R，et al. The microbiological diagnostic performance of metagenomic next-generation sequencing in patients with sepsis [J]. BMC Infect Dis，2021，21（1）：1257- 1265.
[11] Li N，Ma X，Zhou J，et al. Clinical application of metagenomic next-generation sequencing technology in the diagnosis and treatment of pulmonary infection pathogens：A prospective single-center study of 138 patients [J]. J Clin Lab Anal，2022，36（7）：e24498.
[12] Li Y，Sun B，Tang X，et al. Application of metagenomic next-generation sequencing for bronchoalveolar lavage diagnostics in critically ill patients [J]. Eur J Clin Microbiol Infect Dis，2020，39（2）：369-374.
[13] Wu X，Li Y，Zhang M，et al. Etiology of Severe Community-Acquired Pneumonia in Adults Based on Metagenomic Next-Generation Sequencing：A Prospective Multicenter Study [J]. Infect Dis Ther，2020，9（4）：1003-1015.
[14] 骆煜，金文婷，马玉燕，等.5例鹦鹉热衣原体肺炎的诊断及临床特点[J].中华医院感染学杂志，2020，30（22）：3394-3398.
[15] 贝小歌，陈金军，黎倍伶.宏基因组学测序技术在肝硬化脓毒症中的应用[J].临床肝胆病杂志，2021，37（9）：2206-2209.
[16] 许小泽，黄泽伟，刘振密，等.二代测序在脓毒症患者病原学检测中的应用价值[J].中国当代医药，2021，28（23）：195-199，278.
[17] 王佳丽，刘健，曹慧丹.运用宏基因组二代测序诊断鹦鹉热衣原体重症肺炎2例[J].中国医药导报，2022，19（15）：171-174.
[18] Xie Y，Du J，Jin W，et al. Next generation sequencing for diagnosis of severe pneumonia：China，2010-2018 [J]. J Infect，2019，78（2）：158-169.
[19] Simner PJ，Miller S，Carroll KC. Understanding the Promises and Hurdles of Metagenomic Next-Generation Sequencing as a Diagnostic Tool for Infectious Diseases [J]. Clin Infect Dis，2018，66（5）：778-788.
[20] Lin P，Chen Y，Su S，et al. Diagnostic value of metagenomic next-generation sequencing of bronchoalveolar lavage fluid for the diagnosis of suspected pneumonia in immunocompromised patients [J]. BMC Infect Dis，2022 ，22（1）：416- 423.
[21] 张奕杰.应用宏基因组二代测序技术诊断结核病4例并文献复习[J].河北医学，2021，27（8）：1377-1382.
[22] 中华医学会检验医学分会临床微生物学组，中华医学会微生物学与免疫学分会临床微生物学组，中国医疗保健国际交流促进会临床微生物与感染分会.宏基因组高通量测序技术应用于感染性疾病病原检测中国专家共识[J].中华检验医学杂志，2021，44（2）：107-120.
[23] Zhou X，Wu H，Ruan Q，et al. Clinical Evaluation of Diagnosis Efficacy of Active Mycobacterium tuberculosis Complex Infection via Metagenomic Next-Generation Sequencing of Direct Clinical Samples [J]. Front Cell Infect Microbiol，2019，9：351.
[24] 张尧，缪青，金文婷，等.宏基因二代测序技术对慢性肺曲霉病病原学诊断的价值[J].中国临床医学，2020，27（4）：563-566.
[25] Miao Q，Ma Y，Wang Q，et al. Microbiological Diagnostic Performance of Metagenomic Next-generation Sequencing When Applied to Clinical Practice [J]. Clin Infect Dis，2018，67（2）：231-240.
[26] Shi CL，Han P，Tang PJ，et al. Clinical metagenomic sequencing for diagnosis of pulmonary tuberculosis [J]. J Infect，2020，81（4）：567-574.
[27] Forbes JD，Knox NC，Peterson CL，et al. Highlighting Clinical Metagenomics for Enhanced Diagnostic Decision- making：A Step Towards Wider Implementation [J]. Comput Struct Biotechnol J，2018，16：108-120.
[28] Lloyd-Price J，Abu-Ali G，Huttenhower C. The healthy human microbiome [J]. Genome Med，2016，8（1）：51-61.
[29] 戴媛媛，马筱玲.宏基因组二代测序技术在临床病原学诊断中的应用[J].临床检验杂志，2021，39（1）：1-5.
[30] 刘东来，张春涛，王佑春，等.病原宏基因组高通量测序技术质量控制与评价的挑战和思考[J].生物工程学报，2020，36（12）：2598-2609. |
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