Application of metagenomic next-generation sequencing for suspected infected pancreatic necrosis

Lin, Chia-Yen; Bonsu, Abdul Aziz F K; Li, Jiarong; Ning, Caihong; Chen, Lu; Zhu, Song; Zhong, Qian; Shen, Dingcheng; Huang, Gengwen

doi:10.1016/j.pan.2022.07.006

Cited by 7 publications

(8 citation statements)

References 25 publications

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“…The diagnosis, classification, definitions, and managements associated with AP were based on the Revised Atlanta Classification (RAC) ( Banks et al., 2013 ) and American Gastroenterological Association (AGA) guidelines ( Crockett et al., 2018 ; Baron et al., 2020 ), and were also described in our previous studies ( Ning et al., 2019 ; Shen et al., 2021 ; Li et al., 2022 ; Lin et al., 2022 ). Briefly, IPN was defined as the presence of gas bubbles within (peri)pancreatic necrosis on computed tomography (CT) and confirmed by a positive bacterial or fungal culture or Gram stain of (peri)pancreatic necrosis or fluid obtained from the first drainage procedure or the first necrosectomy.…”

Section: Methodsmentioning

confidence: 99%

Escherichia coli infection indicates favorable outcomes in patients with infected pancreatic necrosis

Huang

Peng

Ning

et al. 2023

Front. Cell. Infect. Microbiol.

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IntroductionInfected pancreatic necrosis (IPN) is a severe complication of acute necrotizing pancreatitis with increasing morbidity. Escherichia coli is the most frequently cultured microorganism in IPN. However, the implications of Escherichia coli infection on the outcomes of patients with IPN remain unclear. Therefore, this study aimed to evaluate the clinical impacts of Escherichia coli infection on IPN.MethodsA prospective database with consecutive patients with IPN between January 2010 and April 2022 at a tertiary hospital was post-hoc analyzed. The clinical and microbiological characteristics, surgical management, and follow-up data of patients with and without Escherichia coli infection were compared.ResultsA total of 294 IPN patients were enrolled in this cohort. Compared with non-Escherichia coli infection cases (n=80, 27.2%), patients with Escherichia coli infection (n=214, 72.8%) were characterized by more frequent polymicrobial infections (77.5% vs. 65.0%, P=0.04) but a lower occurrence of severe acute pancreatitis (SAP) (42.5% vs. 61.7%, P=0.003). In addition, significantly lower mortality (12.5% vs. 30.4%, p=0.002), fewer step-up surgical interventions (73.8% vs. 85.1%, P=0.025), and a lower rate of multiple organ failure (MOF) (25.0% vs. 40.2%, P=0.016) were also observed in patients with Escherichia coli infection. Multivariate analysis of mortality predictors indicated that MOF (odds ratio [OR], 6.197; 95% confidence interval [CI], 2.373–16.187; P<0.001) and hemorrhage (OR, 3.485; 95% CI, 1.623–7.487; P=0.001) were independent predictors associated with higher mortality in patients with IPN. Escherichia coli infection was significantly associated with a lower mortality (OR, 0.302; 95% CI, 0.121–0.751; P= 0.01).ConclusionEscherichia coli infection indicates a favorable prognosis in patients with IPN, although the mechanism needs further investigation.

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Section: Methodsmentioning

confidence: 99%

Escherichia coli infection indicates favorable outcomes in patients with infected pancreatic necrosis

Huang

Peng

Ning

et al. 2023

Front. Cell. Infect. Microbiol.

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“…70 To overcome low sensitivity of culture tests, emerging evidence points to the potential of the metagenomic approach based on nextgeneration sequencing technologies in identifying microbial pathogens in blood samples. 71 Because this new assay has other strengths, including shorter turnaround time and the potential of identifying a large number of pathogens, a costeffective analysis is warranted. We should also investigate the usefulness and appropriate interval of follow-up culture tests in patients undergoing drainage of infectious PFCs.…”

Section: Antibiotics For Infection During the Clinical Course Of Acut...mentioning

confidence: 99%

“…Because PFC drainage is often performed even in sterile cases, it should be further explored if antibiotics guided by proactive FNA can lead to better outcomes compared with empiric or no antibiotics in necrotizing pancreatitis 70 . To overcome low sensitivity of culture tests, emerging evidence points to the potential of the metagenomic approach based on next‐generation sequencing technologies in identifying microbial pathogens in blood samples 71 . Because this new assay has other strengths, including shorter turnaround time and the potential of identifying a large number of pathogens, a cost‐effective analysis is warranted.…”

Section: Antibiotics For Infection During the Clinical Course Of Acut...mentioning

confidence: 99%

Time to think prime times for treatment of necrotizing pancreatitis: Pendulum conundrum

Nakai,

Hamada,

Saito

et al. 2023

Digestive Endoscopy

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Pancreatic fluid collections (PFCs) typically develop as local complications of acute pancreatitis and complicate the clinical course of patients with acute pancreatitis and potentially fatal clinical outcomes. Interventions are required in cases of symptomatic walled‐off necrosis (WON) (matured PFCs with necrosis) and pancreatic pseudocysts (matured PFCs without necrosis). In the management of necrotizing pancreatitis and WON, endoscopic ultrasound‐guided transluminal drainage combined with on‐demand endoscopic necrosectomy (i.e. the step‐up approach) is increasingly used as a less invasive treatment modality compared with a surgical or percutaneous approach. Through the substantial research efforts and development of specific devices and stents (e.g. lumen‐apposing metal stents), endoscopic techniques of PFC management have been standardized to some extent. However, there has been no consensus about timing of carrying out each treatment step; for instance, it is uncertain when direct endoscopic necrosectomy should be initiated and finished and when a plastic or metal stent should be removed following clinical treatment success. Despite emerging evidence for the effectiveness of noninterventional supportive treatment (e.g. antibiotics, nutritional support, irrigation of the cavity), there has been only limited data on the timing of starting and stopping the treatment. Large studies are required to optimize the timing of those treatment options and improve clinical outcomes of patients with PFCs. In this review, we summarize the current available evidence on the indications and timing of interventional and supportive treatment modalities for this patient population and discussed clinical unmet needs that should be addressed in future research.

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“…Significantly, mNGS offers notable advantages in diagnosing infections that are rare or difficult to detect, as well as those involving novel or complex pathogens. Additionally, it has shown efficacy in diverse infectious disorders, such as pancreatic infections, and is rapidly transitioning from research settings to clinical laboratories 16 – 18 . Our prospective single-center study has shown the potential value of blood mNGS in diagnosing IPN with affordable cost and shorter turnaround time 18 .…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, it has shown efficacy in diverse infectious disorders, such as pancreatic infections, and is rapidly transitioning from research settings to clinical laboratories 16 – 18 . Our prospective single-center study has shown the potential value of blood mNGS in diagnosing IPN with affordable cost and shorter turnaround time 18 . mNGS of pancreatic fluid aspiration has also been investigated in a small cohort of suspected IPN 19 .…”

Section: Introductionmentioning

confidence: 99%

Metagenomic next-generation sequencing, instead of procalcitonin, could guide antibiotic usage in patients with febrile acute necrotizing pancreatitis: a multicenter, prospective cohort study

Lin,

Li,

Liu

et al. 2024

International Journal of Surgery

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Backgrounds: The effectiveness of procalcitonin-based algorithms in guiding antibiotic usage for febrile acute necrotizing pancreatitis (ANP) remains controversial. Metagenomic next-generation sequencing (mNGS) has been applied to diagnose infectious diseases. We aimed to evaluate the effectiveness of blood mNGS in guiding antibiotic stewardship for febrile ANP. Materials and Methods: The prospective multicenter clinical trial was conducted at seven hospitals in China. Blood samples were collected during fever (T ≥38.5°C) from ANP patients. The effectiveness of blood mNGS, procalcitonin, and blood culture in diagnosing pancreatic infection was evaluated and compared. Additionally, the real-world utilization of antibiotics and the potential mNGS-guided antimicrobial strategy in febrile ANP were also analyzed. Results: From May 2023 to October 2023, a total of 78 patients with febrile ANP were enrolled and 30 patients (38.5%) were confirmed infected pancreatic necrosis (IPN). Compared with procalcitonin and blood culture, mNGS showed a significantly higher sensitivity rate (86.7% vs. 56.7% vs. 26.7%, P<0.001). Moreover, mNGS outperformed procalcitonin (89.5% vs. 61.4%, P<0.01) and blood culture (89.5% vs. 69.0%, P<0.01) in terms of negative predictive value. Blood mNGS exhibited the highest accuracy (85.7%) in diagnosing IPN and sterile pancreatic necrosis (SPN), significantly superior to both procalcitonin (65.7%) and blood culture (61.4%). In the multivariate analysis, positive blood mNGS (OR=60.2, P<0.001) and lower fibrinogen level (OR=2.0, P<0.05) were identified as independent predictors associated with IPN, whereas procalcitonin was not associated with IPN, but with increased mortality (OR=11.7, P=0.006). Overall, the rate of correct use of antibiotics in the cohort was only 18.6% (13/70) and would be improved to 81.4% (57/70) if adjusted according to the mNGS results. Conclusion: Blood mNGS represents important progress in the early diagnosis of IPN, with particular importance in guiding antibiotic usage for patients with febrile ANP.

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Application of metagenomic next-generation sequencing for suspected infected pancreatic necrosis

Cited by 7 publications

References 25 publications

Escherichia coli infection indicates favorable outcomes in patients with infected pancreatic necrosis

Escherichia coli infection indicates favorable outcomes in patients with infected pancreatic necrosis

Time to think prime times for treatment of necrotizing pancreatitis: Pendulum conundrum

Metagenomic next-generation sequencing, instead of procalcitonin, could guide antibiotic usage in patients with febrile acute necrotizing pancreatitis: a multicenter, prospective cohort study

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