Blood plasma metagenomic next-generation sequencing for identifying pathogens of febrile neutropenia in acute leukemia patients

Abstract

To investigate the value of metagenomic next-generation sequencing (mNGS) in acute leukemia (AL) patients with febrile neutropenia (FN). We retrospectively reviewed 37 AL patients with FN and compared the results of mNGS with blood culture (BC) and the clinical features of the mNGS-positive group and the mNGS-negative group. A total of 14 detected pathogens were the final clinical diagnosis, of which 9 strains were detected only by mNGS and 5 strains were detected by both mNGS and BC. The top pathogens were Klebsiella pneumoniae, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. A total of 67.57% (25/37) were bacterial infections, and 2.7% (1/37) were fungal or viral infections. The diagnostic positivity rate of mNGS (25/37, 67.6%) was significantly higher than that of BC (7/37, 18.9%), and the difference was statistically significant (p < 0.05). Then, we explored the clinical distinction between the mNGS-positive group and the mNGS-negative group, and 3 features were filtered, including lymphocyte count (LY), creatinine levels (Cr), and white blood cell count (WBC). Our study demonstrated that early implementation of mNGS can effectively improve the efficacy of pathogen detection in AL patients with FN. The higher diagnostic positivity rate and the ability to detect additional pathogens compared to BC made mNGS a valuable tool in the management of infectious complications in this patient population. Furthermore, the identified clinical features associated with mNGS results provided additional insights for the clinical indication of infection in AL patients with FN.

Molecular Diagnostics for Invasive Fungal Diseases: Current and Future Approaches

“…Metagenomic next-generation sequencing or mNGS is rapidly moving from research to clinical laboratories. Similar to applications of NGS on cultured isolates, this has largely been focused on detection of bacteria and viruses, rather than fungi [195][196][197][198]. In principle, this catch-all approach has the capacity to detect all pathogens-bacteria, viruses, fungi and parasites-simultaneously in a clinical sample.…”

“…Blood, as a common and convenient sample for laboratory testing, has also been studied by mNGS to detect bloodstream pathogens. Overall, several studies have demonstrated that early implementation of mNGS can effectively improve detection of pathogens in blood [196,213]. In one study, mNGS of plasma was compared with blood culture for 37 acute leukemia patients with febrile neutropenia.…”