Value of metagenomic next-generation sequencing in the treatment of community-acquired pneumonia in the elderly
Objective To explore the potential of metagenomic next-generation sequencing(mNGS)in guiding the treatment of community-acquired pneumonia in elderly patients.Methods A retrospective analysis was conducted on the clinical data of 45 elderly patients(aged 60-89 years)with community-acquired pneumonia who were admitted to the department of respiratory medicine at Fujian Medical University Union Hospital from October 2020 to December 2021.All patients underwent pathogen testing using both conventional methods and mNGS.The analysis focused on the etiological detection results of the 45 elderly patients with community-acquired pneumonia,the basis for adjusting the anti-infection regimen,and the outcome of the disease.Based on the pneumonia severity index(PSI),30 cases were classified as low-risk(PSI 1-3),while 15 cases were classified as medium-high risk(PSI 4-5).The study compared the basis for adjusting the treatment plan between these two groups.Results In this study,the detection rate of mNGS was 91.1％(41/45),while the detection rate of the conventional method was 60.0％(27/45).The difference between the two methods was statistically significant(Kappa=0.311,P=0.001).Out of the 24 cases that tested positive for both mNGS and the conventional method,only 2 cases were completely consistent,13 cases were partially consistent,and 9 cases were completely inconsistent.Additionally,26 cases were adjusted based on mNGS or mNGS+routine test results,and 21 of these adjustments were effective.On the other hand,the treatment was effective in 19 patients whose regimens were adjusted based on routine test results or were not adjusted through empirical treatment.Furthermore,a higher proportion of patients in the intermediate-risk group(PSI grade 4-5)adjusted their treatment based on mNGS results compared to the unadjusted or conventionally treated group[80.0％(12/15)vs.20.0％(3/15),x2=4.555,P=0.033].However,the unadjusted or conventionally treated group primarily consisted of low-risk patients.Conclusions mNGS can serve as an effective supplement for detecting the cause of community-acquired pneumonia in elderly individuals.Furthermore,it holds significant value in guiding the management of elderly patients with community-acquired pneumonia,particularly those in the middle and high-risk group(PSI level 4-5).
PneumoniaCommunity-acquired infectionsMacrogene next-sequencing of pathogenic microorganismTherapy
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