Metagenomic next-generation sequencing in the distribution of pathogens in severe pneumonia patients combined with immunosuppression
Objective To analyze the distribution characteristics of pathogens in severe pneumonia patients with different types of immunosuppression using metagenomic next-generation sequencing(mNGS),and to provide a basis for clinical treatment.Methods From January 2021 to January 2022,113 patients with immunosuppression-associated severe pneumonia were treated in the First Affiliated Hospital of Zhengzhou University,among whom 71 patients had the history of long-term glucocorticoid or immunosuppressant therapy(long-term group)and the other 42 patients had other types of immunosuppression(other-type group).Both groups were performed fiberoptic bronchoscopy examination,and the bronchoalveolar lavage fluid samples were harvested for mNGS to analyze the pathogen infection types and distribution characteristics.The anti-infective therapy regimen was adjusted based on mNGS results in 73 patients,and the outcomes were observed.Results Mixed lung infections were common in both groups,with Acinetobacter baumannii,Pneumocystis jirovecii,and Human Herpesvirus 4 as the bacteria,fungi,and viruses detected by mNGS in long-term group,and Acinetobacter baumannii,Aspergillus,and Human Herpesvirus 1 in other-type group.The detection rate of viruses+fungi was higher in long-term group(25.4％)than that in other-type group(7.1％)(x2=4.499,P=0.034),the detection rates of bacteria+fungi and bacteria+fungi+viruses were lower in long-term group(7.0％,19.7％)than those in other-type group(21.4％,38.1％)(x2=4.527,P=0.033;x2=4.135,P=0.043),there were no significant differences in the detection rates of bacteria+viruses,single pathogens(bacteria,viruses,fungi,atypical pathogens)between long-term group(9.9％,11.3％,14.1％,1.4％,2.8％)and other-type group(9.5％,11.9％,2.4％,0,2.4％)(x2=0.007,P=0.935;x2=0.005,P=0.945;x2=2.232,P=0.135;x2=0.587,P=0.443;x2=0.021,P=0.886).The detection rate of Pneumocystis jirovecii was higher in long-term group(46.67％)than that in other-type group(28.0％)(x2=5.130,P-0.023),while the detection rates of Acinetobacter baumannii and Klebsiella pneumoniae were lower in long-term group(11.3％,5.6％)than those in other-type group(23.5％,14.7％)(x2=25.230,P＜0.001;x2=26.440,P＜0.001).Among these 73 patients,48 patients were discharged after showing improvement by adjustment of anti-infective therapy regimen based on mNGS results,20 patients were discharged due to disease deterioration,and 5 resulted in death.Conclusions Mixed infections are common in severe pneumonia patients with different types of immunosuppression.Compared to other types of immunosuppression,long-time use of glucocorticoid or immunosuppressants has a lower risk of infection with Acinetobacter baumannii and Klebsiella pneumoniae,but a higher risk of Pneumocystis jirovecii infection.
severe pneumoniaimmunosuppressionmetagenomic next-generation sequencingpathogen
NETL
NSTL
万方数据
