Validation of metagenomic next-generation sequencing of bronchoalveolar lavage fluid for diagnosis of suspected pulmonary infections in patients with systemic autoimmune rheumatic diseases receiving immunosuppressant therapy

Frontiers in Medicine

Medicine

Shuting Deng¹  Jianchao Ma¹  Nan Jiang¹  Bohou Li¹  Qiong Wu¹  Lixia Xu¹  Zhuo Li¹  Wei Shi¹  Boxi Chen¹  Zhonglin Feng¹  Renwei Huang¹  Xinling Liang¹  Ye Yuan¹  Sijia Li¹  Yiming Tao¹  Ting Lin¹  Feng Wen¹  Wenjian Wang¹  Chaosheng He¹  Siqi Peng²  Xuejiao Hu³  Sichun Wen⁴  Shuangxin Liu⁵ 

[1] Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China;Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China;The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China;Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China;School of Medicine, South China University of Technology, Guangzhou, Guangdong, China;Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China;School of Medicine, South China University of Technology, Guangzhou, Guangdong, China;Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China;The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China;

关键词: metagenomic next-generation sequencing;    systemic autoimmune rheumatic diseases;    immunosuppressants;    bronchoalveolar lavage fluid;    pulmonary infection;    antibiotics;   

DOI  :  10.3389/fmed.2023.1161661

 received in 2023-02-09, accepted in 2023-06-19,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundThe accuracy and sensitivity of conventional microbiological tests (CMTs) are insufficient to identify opportunistic pathogens in patients with systemic autoimmune rheumatic diseases (SARDs). The study aimed to assess the usefulness of metagenomic next-generation sequencing (mNGS) vs. CMTs for the diagnosis of pulmonary infections in patients with SARDs receiving immunosuppressant therapy.MethodsThe medical records of 40 patients with pulmonary infections and SARDs treated with immunosuppressants or corticosteroids were reviewed retrospectively. Bronchoalveolar lavage fluid (BALF) samples were collected from all patients and examined by mNGS and CMTs. Diagnostic values of the CMTs and mNGS were compared with the clinical composite diagnosis as the reference standard.ResultsOf the 40 patients included for analysis, 37 (92.5%) were diagnosed with pulmonary infections and 3 (7.5%) with non-infectious diseases, of which two were considered primary diseases and one an asthma attack. In total, 15 pathogens (7 bacteria, 5 fungi, and 3 viruses) were detected by CMTs as compared to 58 (36 bacteria, 12 fungi, and 10 viruses) by mNGS. Diagnostic accuracy of mNGS was superior to that of the CMTs for the detection of co-infections with bacteria and fungi (95 vs. 53%, respectively, p < 0.01), and for the detection of single infections with fungi (97.5 vs. 55%, respectively, p < 0.01). Of the 31 patients diagnosed with co-infections, 4 (12.9%) were positive for two pathogens and 27 (87.1%) for three or more. The detection rate of co-infection was significantly higher for mNGS than CMTs (95 vs. 16%, respectively, p < 0.01).ConclusionThe accuracy of mNGS was superior to that of the CMTs for the diagnosis of pulmonary infections in patients with SARDs treated with immunosuppressants. The rapid diagnosis by mNGS can ensure timely adjustment of treatment regimens to improve diagnosis and outcomes.

【 授权许可】

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Copyright © 2023 Wen, Peng, Hu, Jiang, Li, Chen, Deng, Yuan, Wu, Tao, Ma, Li, Lin, Wen, Li, Huang, Feng, He, Wang, Liang, Shi, Xu and Liu.