Value of bronchoalveolar lavage fluid metagenomic next-generation sequencing to the diagnosis of pulmonary infection after allogeneic hematopoietic stem cell transplantation
Objective To analyze the results of bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS)and conventional microbiological tests(CMT)of patients with pulmonary infection after allogeneic hematopoietic stem cell transplantation(allo-HSCT),and to explore the value of BALF mNGS to the diagnosis of pulmonary infection after allo-HSCT.Methods From October 2019 to March 2022,49 patients with pulmonary infection after allo-HSCT received bronchoscopy,BALF mNGS and CMT in Henan Cancer Hospital.The etiological diagnosis results and the detection rates of BALF mNGS and CMT were compared,and the therapeutic effect and the prognosis were followed up.Results In 49 patients,the pathogens were detected by BALF mNGS in 47 patients,among whom the viruses were detected in 33 patients(16 cases of Cytomegalovirus,4 of Epstein-barr virus,3 of Polyomavirus,3 of Respiratory Syncytial virus,2 of Varicella-zoster virus,2 of Human herpesvirus-7,2 of Influenza B virus,1 of Parainfluenza virus),the bacteria were detected in 21 patients(7 cases of Pseudomonas aeruginosa,5 of Enterobacter cloacae,3 of Streptococcus pneumoniae,2 of Escherichia coli,2 of Staphylococcus aureus,1 of Acinetobacter baumann,1 of Nocardia),the fungi were detected in 13 patients(6 cases of Pneumocystis jirovecii,5 of Mold,2 of Candida),and Mycobacterium tuberculosis was detected in 3 patients.There were 21 cases of mixed infection(9 cases of bacterium-virus mixed infection,5 of fungus-virus mixed infection,3 of bacterium-fungus mixed infection,2 of bacterium-fungus-virus mixed infection,2 of tuberculosis-virus mixed infection),and 26 cases of single infection.The pathogens were detected by CMT in 13 patients,among whom the viruses were detected in 2 patients(1 case of Cytomegalovirus,1 of Epstein-barr virus),the bacteria were detected in 8 patients(3 cases of Pseudomonas aeruginosa,2 of Enterobacter cloacae,2 of Escherichia coli,1 of Staphylococcus aureus),and the fungi were detected in 3 patients(2 cases of Mucor,1 of Aspergillus fumigatus).No mixed infection was detected by CMT.The detection rates of BALF mNGS for total pathogens(95.92％),bacteria(42.86％),viruses(67.35％),fungi(26.53％)and mixed infection(42.86％)were higher than those of CMT(26.53％,16.33％,4.08％,6.12％,0)(P＜0.05).After the corresponding anti-infection and symptomatic support treatment according to the detection results and drug sensitivity test,40 patients were effectively controlled and discharged,and 9 died of lung infections.Conclusion BALF mNGS has a higher detection rate than CMT for the pathogens in patients with pulmonary infection after allo-HSCT,with obvious advantages especially in detecting mixed pathogens,rare opportunistic pathogens and viruses,and it can direct the formulation of clinical treatment.
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