Early application of metagenomics next-generation sequencing may significantly reduce unnecessary consumption of antibiotics in patients with fever of unknown origin

BMC Infectious Diseases

Research

Jie Zheng¹  Yubin Zhang²  Tianyan Chen³  Yingren Zhao³  Hongmei Chen³  Di Zhang⁴  Lemeng Yao⁴  Mingze Tang⁵  Han Xia⁵ 

[1] Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China;Department of Clinical Laboratory, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China;Department of Infectious Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China;Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China;Department of Scientific Affairs, Hugobiotech Co., Ltd, Beijing, China;

关键词: Metagenomic next-generation sequencing;    Fever of unknown origin;    Pathogen detection;    Consumption of antibiotics;    Pathogen spectrum;   

DOI  :  10.1186/s12879-023-08417-3

 received in 2023-03-24, accepted in 2023-06-22,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMetagenomic next-generation sequencing (mNGS) is a novel nucleic acid method for the detection of unknown and difficult pathogenic microorganisms, and its application in the etiological diagnosis of fever of unknown origin (FUO) is less reported. We aimed to comprehensively assess the value of mNGS in the etiologic diagnosis of FUO by the pathogen spectrum and diagnostic performance, and to investigate whether it is different in the time to diagnosis, length of hospitalization, antibiotic consumption and cost between FUO patients with and without early application of mNGS.MethodsA total of 149 FUO inpatients underwent both mNGS and routine pathogen detection was retrospectively analyzed. The diagnostic performance of mNGS, culture and CMTs for the final clinical diagnosis was evaluated by using sensitivity, specificity, positive predictive value, negative predictive value and total conforming rate. Patients were furtherly divided into two groups: the earlier mNGS detection group (sampling time: 0 to 3 days of the admission) and the later mNGS detection group (sampling time: after 3 days of the admission). The length of hospital stay, time spent on diagnosis, cost and consumption of antibiotics were compared between the two groups.ResultsCompared with the conventional microbiological methods, mNGS detected much more species and had the higher negative predictive (67.6%) and total conforming rate (65.1%). Patients with mNGS sampled earlier had a significantly shorter time to diagnosis (6.05+/-6.23 vs. 10.5+/-6.4 days, P < 0.001) and days of hospital stay (13.7+/-20.0 vs. 30.3 +/-26.9, P < 0.001), as well as a significantly less consumption (13.3+/-7.8 vs. 19.5+/-8.0, P < 0.001) and cost (4543+/-7326 vs. 9873 +/- 9958 China Yuan [CNY], P = 0.001) of antibiotics compared with the patients sampled later.ConclusionsmNGS could significantly improve the detected pathogen spectrum, clinical conforming rate of pathogens while having good negative predictive value for ruling out infections. Early mNGS detection may shorten the diagnosis time and hospitalization days and reduce unnecessary consumption of antibiotics.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

13690_2023_1154_Article_IEq1.gif

Fig. 4

42490_2023_74_Article_IEq62.gif

Fig. 3

13690_2023_1172_Article_IEq6.gif

13690_2023_1172_Article_IEq1.gif