| ObjectiveTo explore the characteristics and clinical application of metagenomic nextgeneration sequencing(m NGS)technology in the etiological diagnosis of infections in patients with hematological malignancies(HM)complicated.MethodsThe clinical data of 45 patients diagnosed with malignant hematologic disease complicated with infection in the Hematology Department,Fujian Medical University Union Hospital from January 2019 to December 2020,were analyzed retrospectively.All the data,including the results of m NGS and traditional culture of clinical specimens(including peripheral blood,bronchoalveolar lavage fluid,pus,sterile body fluids,etc).The clinical characteristics of the patients were described,and compare the positive rate,detection time consuming,the detected pathogen distribution and the consistency of the results between m NGS and traditional culture.In the patients with negative results of traditional culture,compare the therapeutic effects between the patients with positive results and those with negative results of m NGS.To analyze the factors affecting the positive rate of pathogens of by m NGS by single factor analysis.ResultsIn this study,a total of 39 patients with malignant hematologic diseases complicated with infection met the inclusion criteria,including 23 males and 16 females,with an average age of(48.33±14.66)years.A total of 39 microbial specimens were submitted for culture and m NGS,including 25 peripheral blood,6 bronchoalveolar lavage fluid(BALF),3 lung tissue,1 ferter sample,4 sterile body fluid.The positive rate of m NGS test was 71.79%(28/39),higher than that of traditional culture41.03%(16/39)(P=0.011).The average consuming time of m NGS was(32.31±5.34)hours,significantly shorter than hours of traditional culture(91.64±14.77)(P=0.02).Among the 28 m NGS-positive patients,57 strains of pathogens were detected,including 23 strains of bacteria,21 strains of viruses,7 strains of fungi and 6 strains of special pathogens.Sixteen strains of pathogens,including 14 strains of bacteria and 2 strains of fungi were detected patients with traditional culture.The detection rate of m NGS for viruses,fungi and special pathogens was significantly higher than that of traditional culture,and m NGS also has more advantageous in the detection of bacterial pathogens.Among the 39 samples submitted for examination,12 cases of m NGS were positive for the detection of pathogens by traditional culture,among which 2 cases of m NGS were completely consistent with the detection of pathogens by traditional culture,6 cases were partially consistent with the detection of pathogens by traditional culture,and 4cases were completely inconsistent with the detection of pathogens by traditional culture.In the patients whose pathogen couldn’t be detected with conventional culture,the treatment effect of the anti – infection therapy modified according to positive result of m NGS was significantly better than the effect of empirical treatment(81.25% vs28.57%)(P=0.026).Univariate analysis of the influencing factors for m NGS detection showed that there were no influencing factors for the detection rate of m NGS pathogens.ConclusionThe m NGS detection can improve the detection rate of pathogens of infection in patients infected with malignant blood diseases,especially for viruses,fungi and special pathogens.In patients whose pathogens cannot be detected by traditional culture methods,m NGS detection can be used as an effective complementary means to guide the formulation of treatment regimens for disease-resistant microorganisms and help to improve the therapeutic effect.The m NGS has a shorter time consuming than traditional culture,and can quickly detect pathogens in a short time.No factors were found to affect the detection results of m NGS on pathogens.The m NGS detection technology is not affected by multiple clinical factors and is applicable to a wide range of people the diagnosis of infection,better stability. |
