“…The bacterium most commonly detected by NGS was the gram-positive Enterococcus faecium , and infections by gram-positive bacteria were slightly more prevalent. This contrasts with previous studies, which indicated the most identified bacteria were Escherichia coli , and infections by gram-negative bacteria were significantly more prevalent ( Feng et al., 2023 ; Xu et al., 2023 ). This discrepancy may be due to the fact that 82.3% of patients in our study received empiric anti-infective therapy prior to NGS testing, with the majority being treated with carbapenem antibiotics.…”
Section: Discussioncontrasting
confidence: 99%
“…In this study, 51.2% of all patients made adjustment to their antibiotics regimen, with 33.5% of patients predominantly de-escalating or reducing antibiotics based on mNGS results. This observation was similar to the report of previous studies ( Xu et al., 2023 ). The mortality rate of patients whose anti-infective treatment was adjusted according to mNGS was comparable with that of previous patients.…”
BackgroundMetagenomic next-generation sequencing (mNGS) is a novel non-invasive and comprehensive technique for etiological diagnosis of infectious diseases. However, its practical significance has been seldom reported in the context of hematological patients with high-risk febrile neutropenia, a unique patient group characterized by neutropenia and compromised immune responses.MethodsThis retrospective study evaluated the results of plasma cfDNA sequencing in 164 hematological patients with high-risk febrile neutropenia. We assessed the diagnostic efficacy and clinical impact of mNGS, comparing it with conventional microbiological tests.ResultsmNGS identified 68 different pathogens in 111 patients, whereas conventional methods detected only 17 pathogen types in 36 patients. mNGS exhibited a significantly higher positive detection rate than conventional methods (67.7% vs. 22.0%, P < 0.001). This improvement was consistent across bacterial (30.5% vs. 9.1%), fungal (19.5% vs. 4.3%), and viral (37.2% vs. 9.1%) infections (P < 0.001 for all comparisons). The anti-infective treatment strategies were adjusted for 51.2% (84/164) of the patients based on the mNGS results.ConclusionsmNGS of plasma cfDNA offers substantial promise for the early detection of pathogens and the timely optimization of anti-infective therapies in hematological patients with high-risk febrile neutropenia.
“…The bacterium most commonly detected by NGS was the gram-positive Enterococcus faecium , and infections by gram-positive bacteria were slightly more prevalent. This contrasts with previous studies, which indicated the most identified bacteria were Escherichia coli , and infections by gram-negative bacteria were significantly more prevalent ( Feng et al., 2023 ; Xu et al., 2023 ). This discrepancy may be due to the fact that 82.3% of patients in our study received empiric anti-infective therapy prior to NGS testing, with the majority being treated with carbapenem antibiotics.…”
Section: Discussioncontrasting
confidence: 99%
“…In this study, 51.2% of all patients made adjustment to their antibiotics regimen, with 33.5% of patients predominantly de-escalating or reducing antibiotics based on mNGS results. This observation was similar to the report of previous studies ( Xu et al., 2023 ). The mortality rate of patients whose anti-infective treatment was adjusted according to mNGS was comparable with that of previous patients.…”
BackgroundMetagenomic next-generation sequencing (mNGS) is a novel non-invasive and comprehensive technique for etiological diagnosis of infectious diseases. However, its practical significance has been seldom reported in the context of hematological patients with high-risk febrile neutropenia, a unique patient group characterized by neutropenia and compromised immune responses.MethodsThis retrospective study evaluated the results of plasma cfDNA sequencing in 164 hematological patients with high-risk febrile neutropenia. We assessed the diagnostic efficacy and clinical impact of mNGS, comparing it with conventional microbiological tests.ResultsmNGS identified 68 different pathogens in 111 patients, whereas conventional methods detected only 17 pathogen types in 36 patients. mNGS exhibited a significantly higher positive detection rate than conventional methods (67.7% vs. 22.0%, P < 0.001). This improvement was consistent across bacterial (30.5% vs. 9.1%), fungal (19.5% vs. 4.3%), and viral (37.2% vs. 9.1%) infections (P < 0.001 for all comparisons). The anti-infective treatment strategies were adjusted for 51.2% (84/164) of the patients based on the mNGS results.ConclusionsmNGS of plasma cfDNA offers substantial promise for the early detection of pathogens and the timely optimization of anti-infective therapies in hematological patients with high-risk febrile neutropenia.
“…The pooled sensitivity and speci city of mNGS for infectious diseases in hematology patients were 89.6% (95% CI: 88-91) and 56% (95% CI: 44-69), respectively, indicating an excellent diagnostic performance of mNGS for infection in hematology patients. Our results are similar to the data of a retrospective study on the diagnostic performance of mNGS for infection in hematologic patients, in which the sensitivity of mNGS for pathogens was 82.6% and the speci city was 59.0% [29]. Moreover, the pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 2.10 (95% CI: 1.48-3.30), 0.22 (95% CI: 0.15-0.32), and 10.29 (95% CI: 4.61-19.72), respectively.…”
Objectives
Infection is one of the leading causes of death in hematology patients. Metagenomic next-generation sequencing (mNGS) has been applied to diagnose infection. This meta-analysis will focus on systematically assessing the diagnostic value of mNGS for infection in hematology patients.
Methods
We searched for studies that assessed the efficacy of mNGS for the diagnosis of infection in hematology patients published in Embase, PubMed, Cochrane Library, Web of Science, and China National Knowledge Infrastructure from inception to December 31, 2022. The pooled sensitivity and specificity were estimate and subgroup analysis was performed.
Results
The pooled sensitivity and specificity were 89.6% (95%CI: 88–91%) and 56% (95%CI: 44–69%), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 2.10 (95%CI: 1.48–3.30) and 0.22 (95%CI: 0.15–0.32), respectively. And diagnostic odds ratio was 10.29 (95%CI: 4.61–19.72). The SROC (summary receiver operating characteristic) curve revealed an AUC (area under curve) of 0.88 (95%CI: 0.85–0.90). The method of sample selection and the research type/gold standard may be sources of heterogeneity in sensitivity and specificity, respectively.
Conclusion
mNGS has shown good diagnostic efficacy for infection in hematology patients, but it’s important to choose suitable samples for mNGS according to infection types.
“…In certain cases, even no pathogen was detected, a diagnosis of BSI was still made if patients exhibited symptoms of infection, responded positively to anti-infection treatments, and laboratory tests provided supporting evidence. 14 – 16 All the samples were divided into BSI group and non-BSI group according to the final clinical diagnosis, which was determined by retrospective, in-depth chart review conducted independently by two senior physicians with BSI expertise. Fig.…”
Background
Studies on mNGS application in pediatric oncology patients, who are at high risk of infection, are quite limited.
Methods
From March 2020 to June 2022, a total of 224 blood samples from 195 pediatric oncology patients who were suspected as bloodstream infections were enrolled in this study. Their clinical and laboratory data were retrospectively reviewed, and the diagnostic performance of mNGS was assessed.
Results
Compared to the reference tests, mNGS showed significantly higher sensitivity (89.8% vs 32.5%, P < 0.001) and clinical agreement (76.3% vs 51.3%, P < 0.001) in detecting potential pathogens and distinguishing BSI from non-BSI. Especially, mNGS had an outstanding performance for virus detection, contributing to 100% clinical diagnosed virus. Samples from patients with neutropenia showed higher incidence of bacterial infections (P = 0.035). The most identified bacteria were Escherichia coli, and the overall infections by gram-negative bacteria were significantly more prevalent than those by gram-positive ones (90% vs 10%, P < 0.001). Overall, mNGS had an impact on the antimicrobial regimens’ usage in 54.3% of the samples in this study.
Conclusions
mNGS has the advantage of rapid and effective pathogen diagnosis in pediatric oncology patients with suspected BSI, especially for virus.
Impact
Compared with reference tests, mNGS showed significantly higher sensitivity and clinical agreement in detecting potential pathogens and distinguishing bloodstream infections (BSI) from non-BSI.
mNGS is particularly prominent in clinical diagnosed virus detection.
The incidence of bacterial infection was higher in patients with neutropenia, and the overall infection rate of Gram-negative bacteria was significantly higher than that of Gram-positive bacteria.
mNGS affects the antimicrobial regimens’ usage in more than half of patients.
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