Scholarlink

Background <p>Bacterial and fungal pulmonary infections (BFPI) are common in hematological patients and pose significant diagnostic challenges. Metagenomic next-generation sequencing (mNGS) is valuable for diagnosing BFPI. However, for hematological patients with limited access to lower respiratory tract samples (LRTS), the clinical value of blood-mNGS compared to LRTS-mNGS requires further investigation.</p> Methods <p>A retrospective analysis was conducted on 160 cases with suspected pneumonia who underwent both blood-mNGS and LRTS-mNGS within one week. Diagnostic performance and impacts on antimicrobial adjustments were evaluated using clinical composite diagnosis (CCD) as the reference.</p> Results <p>Compared to CCD, LRTS-mNGS showed significantly higher positive percent agreement (PPA) than blood-mNGS [93.7% (119/127) vs. 34.6% (44/127), <i>P</i> &lt; 0.001], with negative percent agreements (NPA) of 87.5% (21/24) and 91.7% (22/24), respectively. Blood-mNGS showed higher PPA in neutropenic than non-neutropenic patients [56.8% (21/37) vs. 25.6% (23/90), <i>P</i> = 0.001], with unique fungal detection advantages, identifying additional fungi in 7 cases: Mucorales (3), <i>Aspergillus</i> spp. (2), both Mucorales and <i>Aspergillus</i> spp. (1), and <i>Pneumocystis</i> spp. (1). Resistance genes were detected only by LRTS-mNGS. mNGS positively influenced antimicrobial adjustments in 54.3% (69/127) of cases, particularly for pathogens with low empirical coverage, such as <i>Legionella</i> spp. (0.0%, 0/7), <i>Pneumocystis</i> spp. (52.4%, 11/21), and Mucorales (55.6%, 5/9). Blood-mNGS detected these pathogens at rates of 71.4% (5/7), 23.8% (5/21), and 77.8% (7/9), respectively.</p> Conclusion <p>LRTS-mNGS outperformed blood-mNGS in diagnostic performance and resistance detection. Blood-mNGS identified pathogens in one-third of BFPI cases, with value for certain fungal infections, especially in hematologic patients with limited LRTS access.</p> Trial registration <p>Not applicable. This study is a retrospective analysis and does not require clinical trial registration.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Respiratory and blood samples metagenomic sequencing in diagnosing pulmonary infections in hematologic patients

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年2月5日

查看全文
  • Chunhui Xu,
  • Lining Zhang,
  • Teng Liu,
  • Guoqing Zhu,
  • Hui Wei,
  • Yizhou Zheng,
  • Jun Shi,
  • Lugui Qiu,
  • Zhijian Xiao,
  • Xiaofan Zhu,
  • Jianxiang Wang,
  • Jian Guo,
  • Yuping Fan,
  • Yijun Song,
  • Erlie Jiang,
  • Sizhou Feng

摘要

Background

Bacterial and fungal pulmonary infections (BFPI) are common in hematological patients and pose significant diagnostic challenges. Metagenomic next-generation sequencing (mNGS) is valuable for diagnosing BFPI. However, for hematological patients with limited access to lower respiratory tract samples (LRTS), the clinical value of blood-mNGS compared to LRTS-mNGS requires further investigation.

Methods

A retrospective analysis was conducted on 160 cases with suspected pneumonia who underwent both blood-mNGS and LRTS-mNGS within one week. Diagnostic performance and impacts on antimicrobial adjustments were evaluated using clinical composite diagnosis (CCD) as the reference.

Results

Compared to CCD, LRTS-mNGS showed significantly higher positive percent agreement (PPA) than blood-mNGS [93.7% (119/127) vs. 34.6% (44/127), P < 0.001], with negative percent agreements (NPA) of 87.5% (21/24) and 91.7% (22/24), respectively. Blood-mNGS showed higher PPA in neutropenic than non-neutropenic patients [56.8% (21/37) vs. 25.6% (23/90), P = 0.001], with unique fungal detection advantages, identifying additional fungi in 7 cases: Mucorales (3), Aspergillus spp. (2), both Mucorales and Aspergillus spp. (1), and Pneumocystis spp. (1). Resistance genes were detected only by LRTS-mNGS. mNGS positively influenced antimicrobial adjustments in 54.3% (69/127) of cases, particularly for pathogens with low empirical coverage, such as Legionella spp. (0.0%, 0/7), Pneumocystis spp. (52.4%, 11/21), and Mucorales (55.6%, 5/9). Blood-mNGS detected these pathogens at rates of 71.4% (5/7), 23.8% (5/21), and 77.8% (7/9), respectively.

Conclusion

LRTS-mNGS outperformed blood-mNGS in diagnostic performance and resistance detection. Blood-mNGS identified pathogens in one-third of BFPI cases, with value for certain fungal infections, especially in hematologic patients with limited LRTS access.

Trial registration

Not applicable. This study is a retrospective analysis and does not require clinical trial registration.