Etiology of Severe Community-Acquired Pneumonia in Adults Based on Metagenomic Next-Generation Sequencing: A Prospective Multicenter Study

Wu, Xiaodong; Li, Yuanyuan; Zhang, Ming; Li, Miaomiao; Zhang, Rong; Lü, Xin; Gao, Wei; Li, Qin; Yang, Xia; Pan, Pinhua; Li, Qiang

doi:10.1007/s40121-020-00353-y

Cited by 97 publications

(95 citation statements)

References 38 publications

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“…In immunocompromised patients, Pneumocystis jirovecii, Candida albicans , and Human betaherpesvirus 5 were the most detected pathogens. According to this data, the mNGS is a powerful method for microbiological diagnosis, especially for mixed infections in immunocompromised patients, which is consistent with previous reports ( Parize et al., 2017 ; Wu et al., 2020 ). As such, mNGS may offers the probability for targeted therapy and improved clinical antibiotic overuse in immunocompromised patients.…”

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

“…In recent years, metagenomic next-generation sequencing (mNGS) has attracted much attention in infectious filed because of its high-throughput capacity and fast turnaround time ( Mitchell and Simner, 2019 ; Xie et al., 2019 ; Zhou et al., 2019 ; Wu et al., 2020 ). For SCAP patients, the pathogen positivity rate was 90.3% for mNGS versus 39.5% for conventional methods ( Wu et al., 2020 ). The feasibility of mNGS for bronchoalveolar lavage fluid (BALF), blood, sputum, transbronchial lung biopsy (TBLB) and even lung biopsy tissues ( Li et al., 2018 ; Liu et al., 2019 ; Chen et al., 2020 ; Li et al., 2020 ; Wu et al., 2020 ) in patients with respiratory infections has been demonstrated in many literatures.…”

Section: Introductionmentioning

confidence: 99%

“…For SCAP patients, the pathogen positivity rate was 90.3% for mNGS versus 39.5% for conventional methods ( Wu et al., 2020 ). The feasibility of mNGS for bronchoalveolar lavage fluid (BALF), blood, sputum, transbronchial lung biopsy (TBLB) and even lung biopsy tissues ( Li et al., 2018 ; Liu et al., 2019 ; Chen et al., 2020 ; Li et al., 2020 ; Wu et al., 2020 ) in patients with respiratory infections has been demonstrated in many literatures. However, the high cost affects the wide application of mNGS in CAP patients.…”

Section: Introductionmentioning

confidence: 99%

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Metagenomic Next-Generation Sequencing for Pathogenic Diagnosis and Antibiotic Management of Severe Community-Acquired Pneumonia in Immunocompromised Adults

Sun

Cai

et al. 2021

Front. Cell. Infect. Microbiol.

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BackgroundMetagenomic next-generation sequencing (mNGS) is a promising technique for pathogens diagnosis. However, application of mNGS in immunocompromised adults with severe community-acquired pneumonia (SCAP) is relatively limited.MethodsWe retrospectively reviewed 23 immunocompromised and 21 immunocompetent SCAP patients with mNGS detection from April 2019 to December 2019. The performances of pathogenic diagnosis and subsequently antibiotic adjustment in immunocompromised SCAP patients were compared to immunocompetent SCAP patients. The defined by days of therapy (DOT) method was used for estimate daily antibiotic use.ResultsThere was a significant difference in the diagnostic positivity rate between mNGS and conventional test in both groups (P<0.001). Compared to immunocompetent patients, more mixed pathogens in immunocompromised patients were found (P=0.023). Before the availability of mNGS, the DOTs in immunocompromise patients were higher than immunocompetent patients (3.0 [3.0, 4.0] vs. 3.0 [2.0, 3.0], P=0.013). Compared to immunocompetent patients, immunocompromised patients had fewer full pathogen covered empirical antibiotic therapy (14.7% vs. 57.1%, P=0.022), more adjustments of antibiotic treatment (87.0%) vs. 57.1%, P=0.027). More than a half (13 of 23) SCAP patients in immunosuppressed group had reduced or downgraded antibiotic adjustments based on the results.ConclusionsmNGS may be a useful technique for detecting mixed pathogens and personalized antibiotic treatment in immunocompromised SCAP patients.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Metagenomic Next-Generation Sequencing for Pathogenic Diagnosis and Antibiotic Management of Severe Community-Acquired Pneumonia in Immunocompromised Adults

Sun

Cai

et al. 2021

Front. Cell. Infect. Microbiol.

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“…In another study, Legoff et al observed that bacterial–viral coinfection was the most frequent combinations [ 20 ]. In 2020, Wu et al reported that the most common combinations were viral–bacterial coinfection and bacterial–bacterial coinfection in patients with normal immune function, while bacterial–viral coinfection and bacterial–fungal coinfection were the most frequent combinations in patients with compromised immune function [ 21 ]. The inconsistency between our study and other studies might result from the low proportion of immunocompromised patients in this study.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Clinical Utility of Metagenomic Next-Generation Sequencing in the Diagnosis of Pulmonary Infection

et al. 2021

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Introduction: We aimed to explore the realworld clinical application value and challenges of metagenomic next-generation sequencing (mNGS) for pulmonary infection diagnosis. Methods: We retrospectively reviewed the results of mNGS and conventional tests from 140 hospitalized patients with suspected pulmonary infections from January 2019 to December 2020. The sample types included bronchoalveolar lavage fluid, lung tissue by transbronchial lung biopsy, pleural effusion, blood, and bronchial sputum. Apart from the mNGS reports that our patients received, an Guijuan Xie and Bo Zhao contributed equally to this work.

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Clinical characteristics and pathogen analysis of bronchoalveolar lavage fluid in elderly patients with community‐acquired pneumonia

Guo

Zhang

Zhu

et al. 2023

Immunity Inflam & Disease

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Objective To analyze the clinical characteristics and bronchoalveolar lavage fluid pathogens in elderly patients with community‐acquired pneumonia (CAP). Methods This was a retrospective observational epidemiological study using that elderly cases diagnosed with community‐acquired pneumonia receiving treatment at the Affiliated Hospital of North China University of Technology, Tangshan Hongci Hospital and Tangshan Fengnan District Hospital of Traditional Chinese Medicine. A total of 92 cases were divided into two groups according to age. There were 44 patients over 75‐year‐old and 48 patients between 65 and 74‐year‐old. Results Compared with the elderly 65 to 74‐year‐old, the elderly over 75‐year‐old with diabetes are more likely to suffer from CAP (35.42% vs. 63.64%, p = 0.007) and are more likely to have mixed infections (6.25% vs. 22.73%, p = 0.023) or larger lesions (45.83% vs. 68.18%, p = 0.031). Their hospital stays will also be extended (39.58% vs. 63.64%, p = 0.020), and the albumin level (37.51 ± 8.92 vs. 30.93 ± 6.58, p = 0.000), the neutrophils level (9.09(6.26–10.63) vs. 7.18(5.35–9.17),p = 0.026) is significantly lower and the d‐dimer (505.42 ± 197.12 vs. 611.82 ± 195.85, p = 0.011), PCT (0.08 ± 0.04 vs. 0.12 ± 0.07, p = 0.001) levels are significantly higher. Conclusion The clinical symptoms and signs of elderly CAP patients are not so typical, and the infection is more serious. Attention should therefore be paid to elderly patients. Hypoalbuminemia and high d‐dimer can predict the prognosis of patients.

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Etiology of Severe Community-Acquired Pneumonia in Adults Based on Metagenomic Next-Generation Sequencing: A Prospective Multicenter Study

Cited by 97 publications

References 38 publications

Metagenomic Next-Generation Sequencing for Pathogenic Diagnosis and Antibiotic Management of Severe Community-Acquired Pneumonia in Immunocompromised Adults

Metagenomic Next-Generation Sequencing for Pathogenic Diagnosis and Antibiotic Management of Severe Community-Acquired Pneumonia in Immunocompromised Adults

Exploring the Clinical Utility of Metagenomic Next-Generation Sequencing in the Diagnosis of Pulmonary Infection

Clinical characteristics and pathogen analysis of bronchoalveolar lavage fluid in elderly patients with community‐acquired pneumonia

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