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Objective <p>Human metapneumovirus (hMPV) is a significant contributor to pediatric respiratory hospitalizations. This study aimed to delineate the epidemiological patterns, clinical characteristics, and outcomes in a large cohort of hospitalized children with hMPV infection.</p> Methods <p>From April 2021 to November 2023, 5,021 children with acute respiratory infections were enrolled at a tertiary care center. Respiratory samples underwent targeted next-generation sequencing (tNGS) for comprehensive microbial detection. Clinical, laboratory, and imaging data were analyzed to compare disease severity between cases with single hMPV detection and those with multiple microbial detections.</p> Results <p>hMPV was detected in 12.5% (629/5,021) of cases. Strikingly, 94.8% (596/629) of these cases had co-detection of additional respiratory microbes, predominantly in hMPV-bacteria-virus (212/596) and hMPV-bacteria (123/596) combinations. Commonly co-detected agents included <i>Haemophilus influenzae</i> (40.8%, 257/629) and <i>Mycoplasma pneumoniae</i> (23.1%, 145/629). Cases with multiple microbial detections were associated with elevated serum amyloid A (median 26.4 vs. 5.9&#xa0;mg/L,<i> P</i> = 0.018), prolonged hospitalization (6.0 vs. 5.0&#xa0;days, <i>P</i> = 0.003), and higher costs (¥8,237.5 vs. ¥3,906.5, <i>P</i> &lt; 0.001). Among the 629 hMPV-positive cases, 309 (49.1%) required respiratory support. Pulmonary consolidation and hypoxemia were the most common respiratory complications, while gastrointestinal dysfunction and myocardial damage were the primary non-respiratory complications. The median hospital stay was 6&#xa0;days. Of these, 34 cases (5.4%) required intensive care unit (ICU) admission, and two cases (0.3%) resulted in mortality. These severe outcomes occurred exclusively in cases where multiple microbes were detected.</p> Conclusion <p>The respiratory microbiome in children hospitalized with hMPV is overwhelmingly complex, with frequent co-detection of multiple microbes (94.8%), which is associated with significant clinical burdens, including prolonged hospitalization, increased need for respiratory support, and higher treatment costs. tNGS, with its ability to simultaneously identify multiple microbes, shows potential diagnostic value in uncovering this complexity and could be promising for guiding clinical management and antibiotic stewardship.</p>

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Complexity of the respiratory microbiome in pediatric hMPV hospitalizations: a tNGS-based study linking microbial co-detection to severe clinical outcomes

  • 期刊论文

  • 发表日期：

    2026年1月16日

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  • Chunyun Fu,
  • Wenting Tang,
  • Junming Lu,
  • Xiangjun Lu,
  • Ya Huang,
  • Qiang Huang,
  • Jiangyang Zhao,
  • Lishai Mo,
  • Yanhua Feng,
  • Xuehua Hu,
  • Yanqing Tang,
  • Shang Yi,
  • Hao Wei,
  • Huiping Huang,
  • Qifei Li,
  • Jie Tan

摘要

Objective

Human metapneumovirus (hMPV) is a significant contributor to pediatric respiratory hospitalizations. This study aimed to delineate the epidemiological patterns, clinical characteristics, and outcomes in a large cohort of hospitalized children with hMPV infection.

Methods

From April 2021 to November 2023, 5,021 children with acute respiratory infections were enrolled at a tertiary care center. Respiratory samples underwent targeted next-generation sequencing (tNGS) for comprehensive microbial detection. Clinical, laboratory, and imaging data were analyzed to compare disease severity between cases with single hMPV detection and those with multiple microbial detections.

Results

hMPV was detected in 12.5% (629/5,021) of cases. Strikingly, 94.8% (596/629) of these cases had co-detection of additional respiratory microbes, predominantly in hMPV-bacteria-virus (212/596) and hMPV-bacteria (123/596) combinations. Commonly co-detected agents included Haemophilus influenzae (40.8%, 257/629) and Mycoplasma pneumoniae (23.1%, 145/629). Cases with multiple microbial detections were associated with elevated serum amyloid A (median 26.4 vs. 5.9 mg/L, P = 0.018), prolonged hospitalization (6.0 vs. 5.0 days, P = 0.003), and higher costs (¥8,237.5 vs. ¥3,906.5, P < 0.001). Among the 629 hMPV-positive cases, 309 (49.1%) required respiratory support. Pulmonary consolidation and hypoxemia were the most common respiratory complications, while gastrointestinal dysfunction and myocardial damage were the primary non-respiratory complications. The median hospital stay was 6 days. Of these, 34 cases (5.4%) required intensive care unit (ICU) admission, and two cases (0.3%) resulted in mortality. These severe outcomes occurred exclusively in cases where multiple microbes were detected.

Conclusion

The respiratory microbiome in children hospitalized with hMPV is overwhelmingly complex, with frequent co-detection of multiple microbes (94.8%), which is associated with significant clinical burdens, including prolonged hospitalization, increased need for respiratory support, and higher treatment costs. tNGS, with its ability to simultaneously identify multiple microbes, shows potential diagnostic value in uncovering this complexity and could be promising for guiding clinical management and antibiotic stewardship.