| Objective:To analyze the pathogen detected by next-generation sequencing(NGS)and investigate the application performance of NGS for pathogen detection in PICU.Methods:A retrospective study was conducted on the results of 479 cases of NGS sent by Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 2018 to June 2019.The result of NGS was analyzed,and that was compared with microbiological culture to evaluate the diagnostic performance of NGS for pathogens.Results:1.The total positivit y rate of NGS sent by P ICU was 86.43%,which was significantl y higher than that of culture 19.83%(P <0.001).Among the three main kinds of samples,the positivit y rate of bronchoalveolar lavage fluid(BALF)was the highest 96.15 %,that of blood samples wa s 77.89%,and that of cerebrospinal fluid(CSF)was the lowest 63.41%(P<0.001).2.Among the 479 samples,virus was detected in 206 samples,fungi was detected in 64 samples,but only 14 cases were tested positive in culture [OR 5.12,95% CI(2.83 to 9.27);P<0.01l].3.In the patients who did not receive antibacterial agents,the positivity rate of NGS was 70.00%,which was higher than that of culture 50.00%,and there was no statistical difference(P =0.625).In the group of receiving antibacterial agents,the positivity rate of NGS was 86.78%,which was higher than that of culture 18.98%,and there was significant statistical difference(P<0.001).4.Among the cases with 451 samples submitted for examination by NGS in the infection group,42 cases were tested negative,62 cases were tested positive with no clinical significance.In 28 cases of the non-infection group,5 cases were tested positive by NGS,which were considered as bacteria colonization(60%)or potential infection(40%).According to the above data,the sensitivity and specificity of NGS detection is 78.29% and 82.14%,respectively.5.The virus detection rate in infant,toddler and preschool group was higher than that in elderly group(P<0.001),and the bacterial detection rate in infant group was significantly higher than that in toddler,preschool and elderly group(P<0.001).With the increase of age,the detection rate of mycoplasma pneumoniae increased gradually,and the detection rate of preschool and elderly group was significantly higher than that of the infant group(P<0.008).The infected pathogens were divided into five types: bacteria,viruses,fungi,mycoplasma/chlamydia and parasites.Two or more kinds of pathogen were detected in 162 samples.Conclusion:1.The total positivity rate of NGS sent by PICU in our hospital was 86.43%.Among the three kinds of samples of BALF,blood and CSF,the positive rate of BALF was the highest(96.15%),followed by blood samples(77.89%)and cerebrospinal fluid(63.41%).The positivity rate of different samples was related to the type of disease.2.NGS was less affected by the use of antibacterial agents,and its positivity rate was higher than that of culture,especially in the detection of viruses,some fastidious bacteria and fungi,and the detection speed is also faster than that of culture,which can well guide clinical diagnosis and treatment,at the same time,NGS can evaluate the therapeutic effect by detecting the sequence number of pathogens detected.3.The sensitivity of NGS in the diagnosis of infectious diseases is 78.29%,and the specificity is 82.14%,indicating NGS has a high diagnostic performance of pathogens and is worth popularizing in clinic.4.The pathogens were different in patients of different ages.In this study,the detection rate of bacteria in the infant group was the highest,the detection rate of virus in the elder group was the lowest,there was no significant difference in the detection rate of fungi among different ages,and the detection rate of mycoplasma pneumoniae increased gradually with the increase of age.And 33.82% of the patients were infected with a mixture of two or more kinds of pathogen. |
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