| Purpose:The application value of Metagenomic Next-Generation Sequencing in etiological distribution,diagnosis and clinical treatment of elderly patients with pulmonary infection.Materials and Methods:Prospective analysis of hospitalized patients with pulmonary infection in the Department of Respiratory and critical Care Medicine and Geriatrics Department of the Neijiang first people’s Hospital from January 2022 to August 2022.Each participant perfected electronic bronchoscopy and bronchoalveolar lavage,and collected two equal volumes of bronchoalveolar lavage fluid,and different detection methods were used for etiological detection.One copy of BALF was sent to the gene testing company for macro gene second generation sequencing,and one copy of BALF was sent to the microbiology laboratory of our hospital for traditional etiological detection,such as bacterial culture,fungal culture,tuberculosis acid-fast staining and so on.The basic clinical data(sex,age,smoking history,drinking history,basic diseases),mNGS test results(including pathogen type,detection time),traditional etiology test results(including pathogen type,detection time),inflammation index,anti-infective treatment plan,imaging focus absorption,symptom improvement and other information were collected.The results of mNGS were compared with those of traditional etiological examination,the positive rate,timeliness and diagnostic efficacy of mNGS and traditional detection were compared,and the clinical value of mNGS in etiological distribution,diagnosis and treatment of pulmonary infection in the elderly was analyzed.Result:1.Basic data: The study included 67 elderly patients with pulmonary infection,including 43 males and 24 females,26 males,0 females,17 males and 0 females.Age of patients included: 69.66 ± 6.95 years old.Basic diseases: there were 6 cases without basic diseases and 61 cases with basic diseases.2.Etiological distribution: 62 were positive for mNGS(92.54%).There were 26 cases of single pathogen infection(38.81%),including 19 cases of simple bacterial pathogen infection(28.35%),4 cases of simple viral pathogen infection(6.00%),and 3cases of simple fungal pathogen infection(4.48%).There were 36 cases(53.73%)of mixed infection,including 31 cases(46.27%)of two kinds of pathogen mixed infection,16 cases(23.88%)of bacterial-fungal mixed infection,11 cases(16.42%)of bacterialviral mixed infection,4cases(6.00%)of fungal-viral mixed infection and5cases(7.46%)of bacterial-fungal-viral mixed infection.Traditional tests showed positive results in 35cases(52.24%),simple bacterial infection in 7 cases(10.45%),simple fungal infection in19 cases(28.39%),and simple viral infection in 4 cases(6.00%).In mixed infection,bacterial-fungal mixed infection was found in 4 cases(6.00%),fungal-viral infection in2 cases(2.99%),and bacterial-viral mixed infection was not detected.3.Etiological structure: Among the 62 mNGS positive cases,a total of 172 pathogens were detected,of which 76 strains(44.19%)were bacteria,mainly Streptococcus pneumoniae 12 strains(6.98%),Haemophilus influenzae 10 strains(5.81%),Klebsiella pneumoniae 6 strains(3.49%).There were 44 strains of fungi(25.58%),mainly Candida albicans 16 strains(9.30%)and Aspergillus fumigatus 11strains(6.40%).There were 41 strains of virus(23.84%),mainly 14 strains of human herpesvirus 4(8.14%)and 9 strains of human herpesvirus type 1(5.23%).There were 8strains of Mycobacterium tuberculosis(4.65%)and 3 strains of atypical pathogens(Chlamydia psittaci),accounting for 1.74%.Among the 35 cases with positive results of traditional tests,a total of 42 strains of pathogens were detected,of which 24 strains(57.14%)were fungi and 13 strains(30.95%)were Candida albicans.11 strains(26.19%)were bacteria,including 3 strains of Klebsiella pneumoniae(7.14%),3 strains of Acinetobacter baumannii(7.14%)and 3 strains of Escherichia coli(7.14%).There were6 strains of virus,accounting for 14.29%.There were mainly 3 strains of influenza virus(7.14%),3 strains of human herpesvirus 4(7.14%),and 1 strain of Mycobacterium tuberculosis(2.38%).4.Comparison between mNGS detection and traditional detection methods: The positive rate of mNGS detection was 92.54%,and that of traditional detection was52.23%.The positive rate of mngs detection was significantly higher than that of traditional detection methods,and the difference was statistically significant(P<0.001).The detection time of mNGS was 1.61±0.58 d.In traditional detection,the time of bacterial culture,fungal culture,concentrated acid-fast staining and virus detection were2.10±0.43 d,4.22±1.15 d,0.98±0.09 d and 0.57±0.27 d,respectively.The time of mNGS detection was significantly shorter than that of traditional bacterial and fungal culture,and the difference was statistically significant(P<0.001).The time of concentrated acidfast staining and virus detection in traditional detection was shorter than that in mNGS detection,and the timeliness of concentrated acid-fast staining and virus detection in traditional detection was significantly lower than that in traditional detection(P<0.001).Among all the results,the sensitivity of mNGS detection is 92.86%,and the sensitivity of traditional detection method is 55.36%.The sensitivity of mNGS pathogen detection was significantly higher than that of traditional etiological detection.The consistency between the mNGS detection results and the traditional detection results was 34.33%.The sensitivity of the pencil mNGS pathogen detection method was significantly higher than that of the traditional etiology detection method,and the difference was statistically significant(P<0.001).5.Treatment plan adjustment: 46 cases(68.66%)made diagnosis and treatment changes according to mNGS test results and/or traditional test results,44 cases(65.67%)adjusted their treatment plan according to mNGS test results,22 cases(32.84%)adjusted treatment plan according to traditional test results,and the adjustment intensity of patients’ treatment plan according to mNGS test results was significantly higher than that of traditional detection,and the difference was statistically significant(P<0.001).6.According to the diagnostic criteria of severe pneumonia,the subjects were divided into severe group 23 cases and non-severe group 44 cases.There was no significant difference in age,sex,smoking history,drinking history and underlying diseases between the two groups(P<0.05).The positive rate of mNGS in severe group was 95.65%,the positive rate of traditional test was 55.22%,the positive rate of mNGS in non-severe group was 90.91%,and the positive rate of traditional detection was 38.63%.The detection rate of pathogens in severe group and non-severe group was higher than that of traditional detection,and the difference was statistically significant.In the severe group,17 cases adjusted the treatment plan according to the mNGS test results,and 12 cases adjusted the treatment plan according to the traditional detection results.The adjustment rate of mNGS results in the severe group was significantly higher than that of the traditional detection,and the difference was statistically significant.7.The subjects were divided into non-underlying disease group(n=6)and basic disease group(n=61)according to the presence or absence of underlying diseases.In the group without underlying disease,the positive rate of mNGS test was 83.33%,and the positive rate of traditional test was 16.67%.In the group with underlying diseases,the positive rate of mNGS was 93.44%,and the positive rate of traditional test was 55.74%.The positive rate of mNGS in basic disease group and non-underlying disease group was significantly higher than that of traditional detection method,and the difference was statistically significant(P<0.05).Conclusion :1.Mixed infection was the most common in elderly patients with pulmonary infection,mainly bacterial-fungal multiple infection.2.Compared with the traditional etiological detection,the positive rate,timeliness and sensitivity of mNGS detection were significantly increased.3.The results of mNGS etiology test can guide the treatment of elderly patients with pulmonary infection and immediately adjust the antibiotic treatment plan,improve prognosis,specially in elderly severe patients. |
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