Application Value Of Next-generation Sequencing In The Diagnosis And Treatment Of Pulmonary Fungal Infection

Objective: By retrospectively comparing whether antifungal therapy were performed in patients with suspected pulmonary infection detected by t NGS and sent for conventional microbiological tests and efficacy analysis,to evaluate the application value of t NGS in the diagnosis and treatment of pulmonary fungal infection.Methods:Cases of inpatients suspected pulmonary infection from the Department of Respiratory and Critical Care Medicine of the Second Hospital of Hebei Medical University from January 2021 to December 2022 were collected,whose bronchoalveolar lavage fluid collected by bronchoscopy was sent for t NGS and fungi were detected.The cases were divided into 2groups,59 cases in the antifungal treatment group,and 15 cases in the non-antifungal treatment group.General clinical information,conventional microbiological tests,inflammatory indicators,chest imaging data and pharmacological treatment were collected.The pathogen detection results of t NGS and conventional microbiological tests were compared statistically,and the clinical efficacy of antifungal treatment group and non-antifungal treatment group were compared.The Patients on antifungal therapy were divided into 2 groups to explore the effect whether to adjust antifungal therapy based on t NGS results on clinical efficacy.Results:A total of 74 patients(59 in the antifungal treatment group and15 in the non-antifungal treatment group)were enrolled.There were significant differences in long-term use of immunosuppressants,immunocompromise,diabetes and ESR(P < 0.05).There were no significant differences in gender,age,antibiotic exposure within 72 hours before collecting BALF,recent glucocorticoid use for more than 3 weeks,underlying diseases(except diabetes),hypoproteinemia,ICU admission,ICU hospitalization days,mechanical ventilation,mechanical ventilation days,inflammatory indexes on admission(except ESR),concentration and signal intensity of fungi detected by t NGS,inflammatory indexes before discharge,and efficacy between 2 groups(P>0.05).There were statistically significant differences in LY before discharge and antifungal treatment days between the antifungal treatment response group and the lack of response group(P < 0.05).Univariate logistic regression analysis found that adjustment of antifungal regimens based on t NGS was protective factor that responded to antifungal therapy(P<0.05,OR 0.152).There was no significant differences in the gender,age,antibiotic exposure within 72 hours before collecting BALF,recent glucocorticoid use for more than 3 weeks,long-term use of immunosuppressants,history of previous fungal infection,underlying diseases,immunocompromise,inflammatory indexes before t NGS,WBC,NE,NE% and LY% before discharge,concentration and signal intensity of fungi detected by t NGS,ICU admission,ICU hospitalization days,mechanical ventilation,mechanical ventilation days,glucocorticoid or PPI for antifungal treatment,blood products transfusion between 2 groups(P>0.05).Conclusions:Compared with conventional microbiological tests,t NGS is superior in the diagnosis of pulmonary fungal infection.Adjusting the antifungal regimens based on t NGS results had a positive effect on efficacy.Long-term use of immunosuppressants and immunodeficiency are relevant factors that affect the decision on antifungal therapy;LY after antifungal therapy and duration of antifungal therapy are relevant factors affecting efficacy.