Clinical study on the diagnostic value of targeted next-generation sequencing of sputum and respiratory pathogens under hypertonic saline nebulization for the microbiological diagnosis of refractory pulmonary infection
Objective To investigate the diagnostic value of targeted next generation sequencing(tNGS)of sputum and respiratory pathogens under hypertonic saline nebulization combined with sputum general pathogen detection for the microbiological diagnosis of refractory pulmonary infection.Methods A total of 50 patients with refractory pulmonary infection admitted to Lecong Hospital of Shunde Foshan from April 2023 to July 2024 were selected as the research objects,and they were divided into the control group(n=16,treated with common pathogen detection of sputum),the observation group A(n=17,treated with hypertonic saline nebulization+respiratory pathogen tNGS+common pathogen detection of sputum),and the observation group B(n=17,treated with hypertonic saline nebulization+common pathogen detection of sputum)according to the random number table method.Through the obtained microbiological results,antibiotic treatment was selected,and the changes of clinical symptoms,dynamic changes of biochemical indices and absorption of chest imaging lesions of patients were observed.Results The disappearance time of fever,cough,expectoration and lung rales in observation group A and observation group B were all significantly shorter than that in the control group,and the disappearance time of fever and cough in observation group A were significantly shorter than that in the observation group B,with statistically significant differences(P＜0.05).Before treatment,there was no statistically significant difference in the levels of white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)among the three groups(P＞0.05).After treatment,the levels of WBC,CRP and PCT in observation group A and observation group B were all significantly lower than those in the control group,and the levels of PCT,CRP and WBC in the observation group A were all lower than those in the observation group B,with statistically significant differences(P＜0.05).After treatment,the levels of PCT,CRP and WBC were all significantly lower than those before treatment,with statistically significant differences(P＜0.05).The results of tNGS of respiratory pathogens showed that bacteria accounted for the highest proportion of pathogens,in which Klebsiella pneumoniae accounted for the highest proportion in bacteria,accounting for 11.76％(2/17),human herpesvirus accounted for the highest proportion in virus,accounting for 17.65％(3/17),aspergillus fumigatus accounted for the highest proportion in fungus,accounting for 3.46％(1/17),and mycobacterium tuberculosis accounted for the highest proportion in other pathogens,accounting for 3.46％(1/17).The focus absorption time of the observation group A and the observation group B was significantly shorter than that of the control group,and the focus absorption time of the observation group A was significantly shorter than that of the observation group B,with statistically significant difference(P＜0.05).Conclusion TNGS,sputum and respiratory pathogens under hypertonic saline nebulization,can accurately identify and diagnose microbiological pathogens of refractory pulmonary infection.For treatment,it can obviously improve the prognosis,alleviate the clinical symptoms and infection indicators of patients,and provide a more economical and effective means for clinical treatment of refractory pulmonary infection,which is recommended to be popularized.
Hypertonic saline nebulizationSputum and respiratory pathogensTargeted next-generation sequencingRefractory pulmonary infectionMicrobiological
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