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Metagenomic Next-Generation Sequencing Successfully Detects Pulmonary Infectious Pathogens in Children With
Dao Wang1, Weilin Wang1, Yanjie Ding1
1Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Background:
Pulmonary infection is a leading cause of mortality in pediatric patients with hematologic malignancy (HM). In clinical settings, pulmonary pathogens are frequently undetectable, and empiric therapies may be costly, ineffective and lead to poor outcomes in this vulnerable population. Metagenomic next-generation sequencing (mNGS) enhances pathogen detection, but data on its application in pediatric patients with HM and pulmonary infections are scarce.
Methods:
We retrospectively reviewed 55 pediatric patients with HM and pulmonary infection who were performed mNGS on bronchoalveolar lavage fluid from January 2020 to October 2021. The performances of mNGS methods and conventional microbiological methods in pathogenic diagnosis and subsequently antibiotic adjustment were investigated.
Results:
A definite or probable microbial etiology of pulmonary infection was established for 50 of the 55 patients (90.9%) when mNGS was combined with conventional microbiological tests. The positive rate was 87.3% (48 of 55 patients) for mNGS versus 34.5% (19 of 55 patients) with conventional microbiological methods (P < 0.001). Bacteria, viruses and fungi were detected in 17/55 (30.9%), 25/55 (45.5%) and 19/55 (34.5%) cases using mNGS, respectively. Furthermore, 17 patients (30.9%) were identified as pulmonary mixed infections. Among the 50 pathogen-positive cases, 38% (19/50) were not completely pathogen-covered by empirical antibiotics and all of them were accordingly made an antibiotic adjustment. In the present study, the 30-day mortality rate was 7.3%.
Conclusion:
mNGS is a valuable diagnostic tool to determine the etiology and appropriate treatment in pediatric patients with HM and pulmonary infection. In these vulnerable children with HM, pulmonary infections are life-threatening, so we recommend that mNGS should be considered as a front-line diagnostic test.
Insights
Metagenomic next-generation sequencing (mNGS) significantly improves pathogen detection in pediatric patients with hematologic malignancy (HM) and pulmonary infections. This advanced method aids in timely antibiotic adjustments, improving outcomes for this vulnerable group.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Genomics
Background:
- Pulmonary infections are a major cause of mortality in pediatric patients with hematologic malignancy (HM).
- Current diagnostic methods often fail to detect pathogens, leading to ineffective empiric therapies and poor outcomes.
- Metagenomic next-generation sequencing (mNGS) shows promise for enhanced pathogen detection in this population, but data is limited.
Purpose of the Study:
- To evaluate the performance of mNGS compared to conventional methods for diagnosing pulmonary infections in pediatric HM patients.
- To assess the impact of mNGS on antibiotic adjustment and patient outcomes.
Main Methods:
- Retrospective review of 55 pediatric patients with HM and pulmonary infection.
- Analysis of bronchoalveolar lavage fluid using mNGS and conventional microbiological methods.
- Comparison of pathogen detection rates and impact on antibiotic therapy.
Main Results:
- mNGS combined with conventional tests established a microbial etiology in 90.9% of patients.
- mNGS demonstrated a significantly higher positive detection rate (87.3%) compared to conventional methods (34.5%).
- Bacteria, viruses, and fungi were detected by mNGS, with 30.9% of cases having mixed infections. 38% of pathogen-positive cases required antibiotic adjustment.
Conclusions:
- mNGS is a valuable tool for identifying the etiology of pulmonary infections in pediatric HM patients.
- Early consideration of mNGS as a front-line diagnostic test is recommended for vulnerable children with HM and pulmonary infections.
- Improved pathogen detection via mNGS facilitates appropriate antibiotic treatment and potentially better outcomes.
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