Effect Of Anti-Infective Therapy Guided By Metagenomic Next-Generation Sequencing Technology On The Prognosis Of Patients With Sepsis:A Single-Center,Retrospective Study

BackgroundSepsis is a common and frequently-occurring disease in Intensive Care Unit(ICU),with rapid progress,high mortality and high cost.Due to the complex pathogenesis and development of sepsis,the difficulty of clinical treatment has been increased.Early etiological diagnosis and the use of antibiotics have obvious benefits for the treatment of sepsis patients.Metagenomic next-generation sequencing is a valuable diagnostic tool for identifying early pathogens in sepsis and guiding the formulation of clinical antibiotic therapy.However,its clinical application and prognostic value in patients with sepsis,compared with traditional culture testing,remain unclear.Research objectiveTo explore the effect of antibiotic use strategies based on metagenomic next-generation sequencing technology on the prognosis of patients with sepsisResearch methodsA retrospective cohort study was conducted to select sepsis patients who met the inclusion and exclusion criteria in the Intensive Care Unit(ICU)of Zhujiang Hospital of Southern Medical University from November 1,2018 to June 30,2021.According to their blood,sputum or bronchoalveolar lavage fluid,cerebrospinal fluid samples of different pathogenic detection method,the septic patients were divided into two groups.The NGS group received metagenomic next-generation sequencing(mNGS)and conventional microbial culture,while the Non-NGS group only received conventional microbial culture.Clinical indicators were collected,including age,sex,fever,shock,hypertension,diabetes,coronary atherosclerotic heart disease,chronic obstructive pulmonary disease,cerebral infarction,APACHEII score,SOFA score.mechanical ventilation,continuous renal replacement therapy,extracorporeal membrane oxygenation,application of vasoactive drug and hormone,and infection indicators.Statistical analysis of propensity score matching was performed to evaluate whether antibiotic strategies based on mNGS could reduce the 28-day mortality in patients with sepsis.ResultsIn this study,we enrolled a total of 326 patients.There were 91 cases in the NGS group and 235 cases in the Non-NGS group.By using 1:2 propensity score matching method for statistical analysis,192 patients were successfully matched.After matching,there were 69 patients in the NGS group,including 33 deaths,and 123 patients in the Non-NGS group,including 87 deaths.Primary outcome measures:The mortality rate in NGS group(47.83%)was significantly lower than that in Non-NGS group(70.73%,P=0.002).Secondary outcome measures:The overall positive rate in NGS group(89.86%)was significantly higher than that in Non-NGS group(51.22%,P<0.001).The positive rate of mNGS in NGS group(88.41%)was significantly higher than that in conventional culture group(30.43%).In the NGS group,the hospitalization duration was longer(P=0.002),the hospitalization cost was higher(P=0.004),the antibiotic use time was longer(P=0.046),there were many kinds of antibiotics(P=0.01),and the DDD value was higher(P=0.003).After adjusting for confounding factors by multivariate COX analysis,antibiotic strategy based on mNGS results was a protective factor for 28-day mortality of patients.The prognosis of patients in the NGS group was better than that in the Non-NGS group(P=0.003),and the septic patients without application of vasoactive drug had a better prognosis(P=0.017).ConclusionsAntibiotic use strategies based on metagenomic next-generation sequencing technology is associated with lower 28-day mortality,and its association with patient outcomes needs to be further validated in large sample,multicenter randomized controlled trials.