Value of metagenomic next-generation sequencing in children with hematological malignancies complicated with infections

ZHONG Shan, YANG Ming-Hua

Chinese Journal of Contemporary Pediatrics ›› 2023, Vol. 25 ›› Issue (7) : 718-725.

PDF(641 KB)
PDF(641 KB)
Chinese Journal of Contemporary Pediatrics ›› 2023, Vol. 25 ›› Issue (7) : 718-725. DOI: 10.7499/j.issn.1008-8830.2212059
CLINICAL RESEARCH

Value of metagenomic next-generation sequencing in children with hematological malignancies complicated with infections

  • ZHONG Shan, YANG Ming-Hua
Author information +
History +

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.

Key words

Hematological malignancy / Metagenomic next-generation sequencing / Infection / Pathogen detection / Child

Cite this article

Download Citations
ZHONG Shan, YANG Ming-Hua. Value of metagenomic next-generation sequencing in children with hematological malignancies complicated with infections[J]. Chinese Journal of Contemporary Pediatrics. 2023, 25(7): 718-725 https://doi.org/10.7499/j.issn.1008-8830.2212059

References

1 Loeffen EAH, Knops RRG, Boerhof J, et al. Treatment-related mortality in children with cancer: prevalence and risk factors[J]. Eur J Cancer, 2019, 121: 113-122. PMID: 31569066. DOI: 10.1016/j.ejca.2019.08.008.
2 Rolston KV, Bodey GP, Safdar A. Polymicrobial infection in patients with cancer: an underappreciated and underreported entity[J]. Clin Infect Dis, 2007, 45(2): 228-233. PMID: 17578784. DOI: 10.1086/518873.
3 Blevins SM, Bronze MS. Robert Koch and the 'golden age' of bacteriology[J]. Int J Infect Dis, 2010, 14(9): e744-e751. PMID: 20413340. DOI: 10.1016/j.ijid.2009.12.003.
4 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.
5 Han D, Li Z, Li R, et al. mNGS in clinical microbiology laboratories: on the road to maturity[J]. Crit Rev Microbiol, 2019, 45(5-6): 668-685. PMID: 31691607. DOI: 10.1080/1040841X.2019.1681933.
6 Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019[J]. N Engl J Med, 2020, 382(8): 727-733. PMID: 31978945. PMCID: PMC7092803. DOI: 10.1056/NEJMoa2001017.
7 许苗苗, 许传军, 陈伟, 等. 宏基因组学第二代测序技术辅助诊断肺新生隐球菌和卡氏肺孢菌混合感染一例[J]. 中华传染病杂志, 2021, 39(2): 109-110. DOI: 10.3760/cma.j.cn311365-20191205-00403.
8 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.
9 中华医学会检验医学分会临床微生物学组, 中华医学会微生物学与免疫学分会临床微生物学组, 中国医疗保健国际交流促进会临床微生物与感染分会. 宏基因组高通量测序技术应用于感染性疾病病原检测中国专家共识[J]. 中华检验医学杂志, 2021, 44(2): 107-120. DOI: 10.3760/cma.j.cn114452-20201026-00794.
10 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.
11 于洋, 张少坤, 陆世涛, 等. 宏基因组二代测序技术在假体周围感染病原诊断中的应用[J]. 中华骨科杂志, 2021, 41(5): 280-288. DOI: 10.3760/cma.j.cn121113-20200830-00532.
12 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.
13 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.
14 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.
15 Ren D, Ren C, Yao R, et al. The microbiological diagnostic performance of metagenomic next-generation sequencing in patients with sepsis[J]. BMC Infect Dis, 2021, 21(1): 1257. PMID: 34915851. PMCID: PMC8675530. DOI: 10.1186/s12879-021-06934-7.
16 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.
17 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.
18 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.
19 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.
20 中国临床肿瘤学会指南工作委员会. 肿瘤放化疗相关中性粒细胞减少症规范化管理指南[J]. 中华肿瘤杂志, 2017, 39(11): 868-878. PMID: 29151295. DOI: 10.3760/cma.j.issn.0253-3766.2017.11.011.
PDF(641 KB)

Accesses

Citation

Detail

Sections
Recommended

/