首页|Impact of next-generation sequencing on antimicrobial treatment in immunocompromised adults with suspected infections

Impact of next-generation sequencing on antimicrobial treatment in immunocompromised adults with suspected infections

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BACKGROUND:Prompt pathogen identification can have a substantial impact on the optimization of antimicrobial treatment.The objective of the study was to assess the diagnostic value of next-generation sequencing(NGS)for identifying pathogen and its clinical impact on antimicrobial intervention in immunocompromised patients with suspected infections.METHODS:This was a retrospective study.Between January and August 2020,47 adult immunocompromised patients underwent NGS testing under the following clinical conditions:1)prolonged fever and negative conventional cultures;2)new-onset fever despite empiric antimicrobial treatment;and 3)afebrile with suspected infections on imaging.Clinical data,including conventional microbial test results and antimicrobial treatment before and after NGS,were collected.Data were analyzed according to documented changes in antimicrobial treatment(escalated,no change,or de-escalated)after the NGS results.RESULTS:The median time from hospitalization to NGS sampling was 19 d.Clinically relevant pathogens were detected via NGS in 61.7％of patients(29/47),more than half of whom suffered from fungemia(n=17),resulting in an antimicrobial escalation in 53.2％of patients(25/47)and antimicrobial de-escalation in 0.2％of patients(1/47).Antimicrobial changes were mostly due to the identification of fastidious organisms such as Legionella,Pneumocystis jirovecii,and Candida.In the remaining three cases,NGS detected clinically relevant pathogens also detected by conventional cultures a few days later.The antimicrobial treatment was subsequently adjusted according to the susceptibility test results.Overall,NGS changed antimicrobial management in 55.3％(26/47)of patients,and conventional culture detected clinically relevant pathogens in 14.9％of the patients(7/47).CONCLUSION:With its rapid identification and high sensitivity,NGS could be a promising tool for identifying relevant pathogens and enabling rapid appropriate treatment in immunocompromised patients with suspected infections.

Immunocompromised patientsNext-generation sequencingAntimicrobial management

Jia Li、Jiazhen Luo、Tao Hu、Ling Cheng、Weiwei Shang、Li Yan

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Department of Intensive Care Unit,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China

Department of Emergency Medicine,Tongji Hospital Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China

Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China

Department of Geriatrics,Tongji Hospital Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China

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National Natural Science Foundation of China

72274067

2024

10.5847/wjem.j.1920-8642.2024.025

世界急诊医学杂志(英文)
浙江大学,浙江大学医学院附属第二医院

世界急诊医学杂志(英文)

ISSN：1920-8642
年,卷(期)：2024.15(2)
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