使用mNGS指导的M. pneumoniae肺炎的精确管理:病原体负载评估和真菌共同检测模式指导抗生素优化
Jiayin Li1, Haiting Wei1, Shuaifeng Wang2
1College of Public Health of Zhengzhou University, Zhengzhou, China; Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
下一代测序 (mNGS) 改善了Mycoplasma pneumoniae肺炎 (MPP) 的诊断,揭示了青少年更高的病原体负载,并指导了抗生素治疗. 还确定了真菌共感染和高M. pneumoniae负载的危险因素.
科学领域:
- 传染性疾病 传染性疾病
- 微生物学 微生物学
- 基因组学就是基因组学.
背景情况:
- 全球的Mycoplasma pneumoniae肺炎 (MPP) 疫情带来了越来越多的耐药病例带来的挑战.
- 传统的MPP诊断方法往往缺乏敏感性.
- 有限的证据存在于影响MNGS和共同检测的真菌中M. pneumoniae负载的因素,影响抗生素优化.
研究的目的:
- 研究下一代测序 (mNGS) 在优化MPP的诊断和治疗中的关键作用.
- 确定与M. pneumoniae负载和MPP患者的共感染相关的因素.
- 评估抗生素调整对MPP临床结果的影响.
主要方法:
- 对305名确诊的MPP患者进行了回顾性分析.
- 使用mNGS检测M. pneumoniae在传统方法的阴性病例中.
- 雇佣了斯皮尔曼相关性,物流回归,频率统计,关联规则挖掘 (先验) 和奇平方测试来分析病原体负载,共同检测和治疗结果.
主要成果:
- mNGS在74名患者中发现了M.肺炎,这些患者在传统诊断中错过了.
- 与年轻成年人相比,在青少年 (≤18岁) 中观察到较高的M. pneumoniae序列计数 (SC).
- 发烧,血清LDH升高和中性粒细胞百分比降低是高SC的独立风险因素. 在23.9%的患者中存在真菌共感染 (Candida albicans,Aspergillus flavus,Aspergillus fumigatus),A. fumigatus和A. flavus之间具有协同作用.
- 抗生素调整显著改善了治疗的有效性 (OR = 5.33,p < 0.001).
结论:
- 青少年表现出较高的M. pneumoniae负载,发烧和升高的LDH与病原体负载正相关.
- 在Aspergillus fumigatus和Aspergillus flavus之间确定了一个协同协同检测模式.
- mNGS有效指导MPP诊断和抗生素治疗,通过整合病原体负载量化和联合检测概况,从而实现精确的治疗.
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