Application of metagenomic next-generation sequencing of bronchoalveolar lavage fluid in the diagnosis and treatment of refractory pneumonia in children
FENG Rong-Guang, ZHOU Li-Yan, DOU Rui, ZHOU Xue-Yuan, WANG Li-Rong, HAN Li-Hong, WANG Yu-Min
Department of Pediatric Internal Medicine, Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, Hohhot 010020, China (Wang Y-M, Email: wangyumin080102@163.com)
Abstract Objective To investigate the clinical application of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) in the etiological diagnosis and treatment of refractory pneumonia (RTP) in children. Methods A retrospective analysis was performed on 160 children with RTP who were admitted to the Department of Pediatric Internal Medicine, Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, from January 2020 to March 2023. According to whether mNGS was performed, they were divided into two groups: mNGS (n=80) and traditional testing (n=80). All children received the tests of inflammatory markers and pathogen tests after admission. Traditional pathogenicity tests included microbial culture (sputum specimen collected by suction tube), nucleic acid detection of respiratory pathogens, and serological test (mycoplasma, tuberculosis, and fungi). For the mNGS group, BALF specimens were collected after bronchoscopy and were sent to the laboratory for mNGS and microbial culture. The two groups were analyzed and compared in terms of the detection of pathogens and treatment. Results Compared with the traditional testing group, the mNGS group had a significantly higher detection rate of pathogens (92% vs 58%, P<0.05), with more types of pathogens and a higher diagnostic rate of mixed infections. Compared with the traditional testing group, the mNGS group had a significantly higher treatment response rate and a significantly lower incidence rate of complications during hospitalization (P<0.05). Treatment was adjusted for 68 children in the mNGS group according to the results of mNGS, with a treatment response rate of 96% (65/68) after adjustment. Conclusions Compared with traditional pathogen tests, BALF mNGS can significantly improve the detection rate of pathogens and find some rare pathogens. In clinical practice, when encountering bottlenecks during the diagnosis and treatment of children with RTP, it is advisable to promptly perform the mNGS to identify the pathogens.
FENG Rong-Guang,ZHOU Li-Yan,DOU Rui et al. Application of metagenomic next-generation sequencing of bronchoalveolar lavage fluid in the diagnosis and treatment of refractory pneumonia in children[J]. CJCP, 2023, 25(12): 1253-1258.
FENG Rong-Guang,ZHOU Li-Yan,DOU Rui et al. Application of metagenomic next-generation sequencing of bronchoalveolar lavage fluid in the diagnosis and treatment of refractory pneumonia in children[J]. CJCP, 2023, 25(12): 1253-1258.
Fang Z, Lin S, Luo S, et al. Meta-analysis and systematic review of electronic bronchoscopy in refractory pneumonia[J]. Ann Palliat Med, 2021, 10(9): 9889-9901. PMID: 34628915. DOI: 10.21037/apm-21-2133.
Simner PJ, Miller S, Carroll KC. Understanding the promises and hurdles of metagenomic next-generation sequencing as a diagnostic tool for infectious diseases[J]. Clin Infect Dis, 2018, 66(5): 778-788. PMID: 29040428. PMCID: PMC7108102. DOI: 10.1093/cid/cix881.
Chen J, Zhao Y, Shang Y, et al. The clinical significance of simultaneous detection of pathogens from bronchoalveolar lavage fluid and blood samples by metagenomic next-generation sequencing in patients with severe pneumonia[J]. J Med Microbiol, 2021, 70(1): 001259. PMID: 33231537. DOI: 10.1099/jmm.0.001259.
Huang J, Jiang E, Yang D, et al. Metagenomic next-generation sequencing versus traditional pathogen detection in the diagnosis of peripheral pulmonary infectious lesions[J]. Infect Drug Resist, 2020, 13: 567-576. PMID: 32110067. PMCID: PMC7036976. DOI: 10.2147/IDR.S235182.
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.
Wallihan R, Ramilo O. Community-acquired pneumonia in children: current challenges and future directions[J]. J Infect, 2014, 69(Suppl 1): S87-S90. PMID: 25264163. DOI: 10.1016/j.jinf.2014.07.021.
