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How mNGS transforms care for non-verbal elderly stroke patients with pneumonia
1Department of Respiratory and Critical Care Medicine, Guangxi Jiangbin Hospital, Nanning, Guangxi, China.
Background:
Stroke-associated pneumonia (SAP) is a severe complication in non-verbal elderly stroke patients, with diagnosis hindered by the low sensitivity and slow turnaround of conventional microbial culture.
Methods:
A single-center retrospective cohort study was conducted on 64 non-verbal elderly SAP patients (≥65 years) admitted to Guangxi Jiangbin Hospital from 2018 to 2022, divided into an mNGS group (n=30, sputum/BALF tested by metagenomic next-generation sequencing) and a control group (n=34, conventional culture). Propensity score matching (1:1) was used to balance baseline characteristics, and clinical outcomes and pathogen detection efficiency were compared between groups. Multivariable Cox regression adjusted for hypoalbuminemia, electrolyte disturbance and stroke severity.
Results:
mNGS detected more bacterial pathogens (37 vs.27 in sputum, 37 vs.21 in BALF) and identified 3 viral and 2 atypical pathogens undetectable by culture, with a negative rate of 13.3% (vs.20.0% for sputum culture, 43.3% for BALF culture). 73.3% of mNGS group patients received antimicrobial therapy adjustment. After adjustment, the mNGS group had notably higher 28-day (96.7% vs.76.5%; adjusted HR = 0.32, P = 0.032) and 90-day survival (76.7% vs.44.1%; adjusted HR = 0.41, P = 0.024), lower invasive mechanical ventilation rate (40.0% vs.64.7%, P = 0.048), shorter median antibiotic duration (14 vs.21 days, P = 0.016) and lower median hospitalization costs (¥32,450 vs.¥89,310, P < 0.001).
Conclusion:
mNGS enables more comprehensive pathogen detection in non-verbal elderly SAP patients, guides targeted antimicrobial therapy, and is associated with improved survival and reduced healthcare resource consumption. However, large-sample multicenter prospective studies are needed to validate these findings due to the study's limitations.
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