Diagnostic performance and clinical impact of blood metagenomic next-generation sequencing in ICU patients suspected monomicrobial and polymicrobial bloodstream infections

Frontiers in Cellular and Infection Microbiology

Cellular and Infection Microbiology

Xiaojing Liu¹  Bingxue Hu²  Huan Xu²  Qilong Liu³  Ning Ma³  Hongfu Yang³  Yunwei Zhang³  Xiaoge Sun³  Pengfei Li³  Rongqing Sun³ 

[1] Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China;Department of Scientific Affairs, Vision Medicals for Infectious Diseases, Guangzhou, Guangdong Province, China;Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China;

关键词: bloodstream infection;    intensive care unit;    blood culture;    metagenomics next generation sequencing;    polymicrobial infection;   

DOI  :  10.3389/fcimb.2023.1192931

 received in 2023-03-24, accepted in 2023-06-09,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionEarly and effective application of antimicrobial medication has been evidenced to improve outcomes of patients with bloodstream infection (BSI). However, conventional microbiological tests (CMTs) have a number of limitations that hamper a rapid diagnosis.MethodsWe retrospectively collected 162 cases suspected BSI from intensive care unit with blood metagenomics next-generation sequencing (mNGS) results, to comparatively evaluate the diagnostic performance and the clinical impact on antibiotics usage of mNGS.Results and discussionResults showed that compared with blood culture, mNGS detected a greater number of pathogens, especially for Aspergillus spp, and yielded a significantly higher positive rate. With the final clinical diagnosis as the standard, the sensitivity of mNGS (excluding viruses) was 58.06%, significantly higher than that of blood culture (34.68%, P<0.001). Combing blood mNGS and culture results, the sensitivity improved to 72.58%. Forty-six patients had infected by mixed pathogens, among which Klebsiella pneumoniae and Acinetobacter baumannii contributed most. Compared to monomicrobial, cases with polymicrobial BSI exhibited dramatically higher level of SOFA, AST, hospitalized mortality and 90-day mortality (P<0.05). A total of 101 patients underwent antibiotics adjustment, among which 85 were adjusted according to microbiological results, including 45 cases based on the mNGS results (40 cases escalation and 5 cases de-escalation) and 32 cases on blood culture. Collectively, for patients suspected BSI in critical condition, mNGS results can provide valuable diagnostic information and contribute to the optimizing of antibiotic treatment. Combining conventional tests with mNGS may significantly improve the detection rate for pathogens and optimize antibiotic treatment in critically ill patients with BSI.

【 授权许可】

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Copyright © 2023 Liu, Liu, Hu, Xu, Sun, Li, Zhang, Yang, Ma and Sun