Diagnostic Value of Metagenomic Next-Generation Sequencing for Pneumonia in Immunocompromised Patients
Jun Li1, Chao-E Zhou1, Shan-Chen Wei1
1Department of Geriatrics, Peking University First Hospital, Peking University, Beijing 100034, China.
Introduction:
The diagnosis of pulmonary infection and the identification of pathogens are still clinical challenges in immunocompromised patients. Metagenomic next-generation sequencing (mNGS) has emerged as a promising infection diagnostic technique. However, its diagnostic value in immunocompromised patients needs further exploration.
Purposes:
This study was to evaluate the diagnostic value of mNGS compared with comprehensive conventional pathogen tests (CTs) in the etiology of pneumonia in immunocompromised patients and immunocompetent patients.
Methods:
We retrospectively reviewed 53 patients who were diagnosed with pneumonia from May 2019 to June 2021. There were 32 immunocompromised patients and 21 immunocompetent patients with pneumonia who received both mNGS and CTs. The diagnostic performance was compared between mNGS and CTs in immunocompromised patients, using the composite diagnosis as the reference standard. And, the diagnostic value of mNGS for mixed infections was further analyzed.
Results:
Compared to immunocompetent patients, the most commonly pathogens, followed by Cytomegalovirus, Pneumocystis jirovecii and Klebsiella pneumoniae in immunocompromised patients. Furthermore, more mixed infections were diagnosed, and bacterial-fungal-virus coinfection was the most frequent combination (43.8%). mNGS can detect more types of pathogenic microorganisms than CTs in both groups (78.1% vs. 62.5%, P = 0.016and 57.1% vs. 42.9%, P = 0.048). The overall diagnostic positive rate of mNGS for pathogens was higher in immunocompromised patients (P = 0.002). In immunocompromised patients, a comparable diagnostic accuracy of mNGS and CTs was found for bacterial, fungal, and viral infections and coinfection. mNGS had a much higher sensitivity for bacterial infections (92.9% vs. 50%, P < 0.001) and coinfections (68.8% vs. 48.3%, P < 0.05), and it had no significant advantage in the detection of fungal infections, mainly due to the high sensitivity for Pneumocystis jirovecii in both groups.
Conclusion:
mNGS is more valuable in immunocompromised patients and exhibits apparent advantages in detecting bacterial and mixed infections. It may be an alternative or complementary diagnostic method for the diagnosis of complicated infections in immunocompromised patients.
Insights
Metagenomic next-generation sequencing (mNGS) offers superior detection of bacterial and mixed pulmonary infections in immunocompromised patients compared to conventional tests. This advanced technique aids in diagnosing complex infections, improving patient outcomes.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Genomics
Background:
- Diagnosing pulmonary infections in immunocompromised patients remains challenging.
- Metagenomic next-generation sequencing (mNGS) shows promise for pathogen identification.
- Further evaluation of mNGS in immunocompromised populations is needed.
Purpose of the Study:
- To compare the diagnostic value of mNGS against conventional tests (CTs) for pneumonia etiology.
- To assess mNGS performance in both immunocompromised and immunocompetent patients.
- To analyze mNGS's capability in detecting mixed infections.
Main Methods:
- Retrospective review of 53 pneumonia patients (32 immunocompromised, 21 immunocompetent) from May 2019 to June 2021.
- Both mNGS and CTs were performed on all patients.
- Diagnostic performance was compared using composite diagnosis as the reference standard.
Main Results:
- mNGS detected more pathogen types than CTs in both patient groups.
- The overall positive diagnostic rate for mNGS was higher in immunocompromised patients.
- mNGS demonstrated significantly higher sensitivity for bacterial infections and coinfections compared to CTs.
Conclusions:
- mNGS is more valuable for diagnosing infections in immunocompromised patients, especially bacterial and mixed types.
- mNGS serves as a valuable alternative or complementary diagnostic tool for complex infections.
- The study highlights mNGS's advantages in identifying a broader range of pathogens.
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