| Objective:Explore the diagnostic performance of mNGS in causative agent of pulmonary infectious,and analyse the effect of mNGS on adjustment of anti-infection strategies。Methods:We retrospectively analyzed the clinical data of 79 patients diagnosed with pulmonary infection in the department of Respiratory and Critical Care Medicin,intensive Medicine and Hematology of the first Hospital of Shanxi Medical University from September 2019 to February 2021,whom all accepted bronchoscopy and alveolar lavage and collected BALF to test the aditional diagnostic techniques(bacterial culture,fungal culture,acid-fast staining)and mNGS at the same time。Divided those patients into severe group(29 cases)/non-severe group(50 cases),combined basic lung disease group(15 cases)/non-base lung disease group(64 cases)。Compare the results of traditional methods and mNGS,to explore the positive rate and diagnostic performance of mNGS in different groups and types of pathogens,and to analyse the effect of mNGS on adjustment of anti-infection strategies。Results:1.In 79 patients,67 were positive in mNGS,There were 5 types of pathogens,81 types of strains and 227 strains;38 were positive in traditional methods,There were 3types of pathogens,27 types of strains and 57 strains。Compared with the traditional methods,the mNGS detectable microbial types are more comprehensive and the detection strains are more abundant。2.Compared with the traditional methods,mNGS can significantly increase the positive rate of microorganisms,Especially G-bacteria,fungi,tuberculosis,difference was statistically significant(P <0.05)。In non-severe,non-basic lung diseases,mNGS can significantly increase the positive rate of microorganisms,statistically significant(P<0.05)。3.In pulmonary infection,the sensitivity of mNGS is 98.21%,specificity is 52.17%,positive predictive value is 83.33%,negative predictive value is 92.31%。In severe group,mNGS sensitivity is 100%,specificity is 46.15%,positive predictive value is 48.15%,negative predictive value is 100%;In non-severe group,mNGS sensitivity is 96.67%,positive predictive value is 85.71%;In the group of combined basic lung disease,mNGS sensitivity is 100% and positive predictive value is 100%;In non-base lung disease group,mNGS sensitivity is 97.56%,specificity is 52.17%,positive predictive value is 78.43%,negative predictive value is 92.31%。In different types of pathogensmngs,mNGS has high sensitivity and negative predictive values。4.in the patients of lung infection,mNGS directed 49.36% of patients to adjust the anti-infection program;In the severe group,65.52% of the patients adjusted their anti-infective program,In the non-severe group,40.00% of the patients adjusted their anti-infection regimen,Compared with the non-severe group,More people in the severe group adjusted their anti-infection regimen,statistically significant(P=0.029)。60.00% of patients with basal lung disease adjusted their anti-infection regimen,46.88% of the patients in the nonbasic lung disease group adjusted their anti-infection regimen,No statistical significance。Conclusion:1.compared with the traditional etiological detection methods,the mNGS detectable microbial types are more comprehensive,and the detection strains are more and more abundant,especially caustic bacteria,rare bacteria。2.The positive rate of mNGS detection of microorganisms was significantly higher than that of traditional methods,especially in G-bacteria,fungi,tuberculosis。3.mNGS has high sensitivity and negative predictive values of diagnosis of pulmonary infection and detection of pathogens,which is of great significance for microbial diagnosis and exclusion.4.mNGS results can guide clinical adjustment of anti-infection strategies,especially in severe groups。... |
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