Value of metagenomic next-generation sequencing in children with hematological malignancies complicated with infections
ZHONG Shan, YANG Ming-Hua
Department of Pediatrics, Third Xiangya Hospital of Central South University/Hunan Clinical Research Center of Pediatric Cancer, Changsha 410013, China
Abstract Objective To explore the value of metagenomic next-generation sequencing (mNGS) in the pathogen identification in children with hematological malignancies complicated with infections. Methods A retrospective analysis was conducted on clinical data and pathogenic test results of 43 children with hematological malignancies who underwent microbial culture and mNGS due to infections in the Third Xiangya Hospital of Central South University between June 2020 and July 2022. Differences in detection rates and characteristics of pathogenic microorganisms detected by mNGS and microbial culture were compared. Results A total of 54 specimens were examined, and the overall detection rate of pathogen by mNGS (80%, 43/54) was significantly higher than that by microbial culture (30%, 16/54) (P<0.001). The most commonly detected infection type by mNGS was viral infection, followed by fungal infection combined viral infection, while that by microbial culture was bacterial infection, followed by fungal infection. The detection rate of fungi by mNGS (33%, 18/54) was higher than that by microbial culture (6%, 3/54) (P<0.001). The detection rate of two or more pathogenic microorganisms by mNGS was higher at 48% compared to microbial culture at 9% (P<0.05). The detection rate of two or more types of pathogenic microorganisms by mNGS was also significantly higher at 33% compared to microbial culture at 2% (P<0.05). The most commonly detected bacteria and fungi by mNGS were Pseudomonas aeruginosa and Candida tropicalis, respectively, in peripheral blood, while Streptococcus pneumoniae and Pneumocystis jirovecii were most commonly detected in bronchoalveolar lavage fluid. Treatment adjustments based on mNGS results were beneficial for 35% (15/43) of the cases. Conclusions mNGS has a higher detection rate than microbial culture and has obvious advantages in diagnosing mixed and fungal infections, making it a useful supplementary diagnostic method to microbial culture.
ZHONG Shan,YANG Ming-Hua. Value of metagenomic next-generation sequencing in children with hematological malignancies complicated with infections[J]. CJCP, 2023, 25(7): 718-725.
ZHONG Shan,YANG Ming-Hua. Value of metagenomic next-generation sequencing in children with hematological malignancies complicated with infections[J]. CJCP, 2023, 25(7): 718-725.
Montassier E, Batard E, Gastinne T, et al. Recent changes in bacteremia in patients with cancer: a systematic review of epidemiology and antibiotic resistance[J]. Eur J Clin Microbiol Infect Dis, 2013, 32(7): 841-850. PMID: 23354675. DOI: 10.1007/s10096-013-1819-7.
Miller S, Chiu C. The role of metagenomics and next-generation sequencing in infectious disease diagnosis[J]. Clin Chem, 2021, 68(1): 115-124. PMID: 34969106. DOI: 10.1093/clinchem/hvab173.
Zhang M, Wang Z, Wang J, et al. The value of metagenomic next-generation sequencing in hematological malignancy patients with febrile neutropenia after empiric antibiotic treatment failure[J]. Infect Drug Resist, 2022, 15: 3549-3559. PMID: 35837537. PMCID: PMC9273631. DOI: 10.2147/IDR.S364525.
Tumbarello M, Trecarichi EM, Caira M, et al. Derivation and validation of a scoring system to identify patients with bacteremia and hematological malignancies at higher risk for mortality[J]. PLoS One, 2012, 7(12): e51612. PMID: 23272123. PMCID: PMC3522733. DOI: 10.1371/journal.pone.0051612.
Arman G, Zeyad M, Qindah B, et al. Frequency of microbial isolates and pattern of antimicrobial resistance in patients with hematological malignancies: a cross-sectional study from Palestine[J]. BMC Infect Dis, 2022, 22(1): 146. PMID: 35144553. PMCID: PMC8832646. DOI: 10.1186/s12879-022-07114-x.
Wang D, Wang W, Ding Y, et al. Metagenomic next-generation sequencing successfully detects pulmonary infectious pathogens in children with hematologic malignancy[J]. Front Cell Infect Microbiol, 2022, 12: 899028. PMID: 35837477. PMCID: PMC9273861. DOI: 10.3389/fcimb.2022.899028.
Miao Q, Ma Y, Wang Q, et al. Microbiological diagnostic performance of metagenomic next-generation sequencing when applied to clinical practice[J]. Clin Infect Dis, 2018, 67(suppl_2): S231-S240. PMID: 30423048. DOI: 10.1093/cid/ciy693.
Wang Q, Miao Q, Pan J, et al. The clinical value of metagenomic next-generation sequencing in the microbiological diagnosis of skin and soft tissue infections[J]. Int J Infect Dis, 2020, 100: 414-420. PMID: 32898669. DOI: 10.1016/j.ijid.2020.09.007.
Tao Y, Yan H, Liu Y, et al. Diagnostic performance of metagenomic next-generation sequencing in pediatric patients: a retrospective study in a large children's medical center[J]. Clin Chem, 2022, 68(8): 1031-1041. PMID: 35704075. DOI: 10.1093/clinchem/hvac067.
Baden LR, Swaminathan S, Angarone M, et al. Prevention and treatment of cancer-related infections, version 2.2016, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2016, 14(7): 882-913. PMID: 27407129. DOI: 10.6004/jnccn.2016.0093.