宏基因组二代测序对脓毒症患者血流感染的病原学诊断价值

Etiological diagnostic value of metagenomic Next Generation Sequencing for bloodstream infection in patients with sepsis

目的评价宏基因组二代测序(metagenomic next generation sequencing,mNGS)对脓毒症患者血流感染的病原学诊断的价值。方法回顾性分析2021年9月至2023年8月在川北医学院附属医院重症医学科住院期间同时完善了血液mNGS及血培养检查的105例脓毒症病例,根据mNGS及血培养有无阳性结果将病例分为两组,阳性组及阴性组,分析了入组病例病原体分布情况、各组患者在临床特征等方面的差异,同时比较了mNGS与血培养的诊断性能及一致性,评价mNGS对脓毒症患者血流感染的病原学诊断价值。结果①105份血样本中,mNGS有阳性结果的病例为61例(58.10%),血培养阳性结果的病例为32例(30.48%),mNGS的阳性率高于血培养,差异有统计学意义(P<0.05)。mNGS的准确率低于血培养。②阳性组患者的ESR、PCT及CRP的均数高于阴性组,脓毒性休克的比例大于阴性组,差异有统计学意义(P<0.05)。两组病例28 d病死率差异无统计学意义(P>0.05)。结论mNGS有利于脓毒症患者血流感染的病原学诊断和治疗。

Objective To evaluate the value of metagenomic Next Generation Sequencing(mNGS)for the pathogenetic diagnosis of bloodstream infections in patients with sepsis.Methods A retrospective analysis was performed on 105 sepsis cases who received blood mNGS and blood culture tests during their hospitalization in the Intensive Care Department of the Affiliated Hospital of North Sichuan Medical College from September 2021 to August 2023,and the results were compared and analyzed.According to mNGS and blood culture results,the cases were divided into the positive group and negative group.The distribution of pathogens in the enrolled patients were analyzed,and the diagnostic performance and consistency of blood culture and mNGS were compared.The differences in clinical characteristics of patients in each group were analyzed,and the pathogenic diagnostic value of mNGS for bloodstream infections in patients with sepsis was evaluated.Results①Among 105 blood samples,61 cases(58.10%)had positive results of mNGS,and 32 cases(30.48%)had positive results of blood culture.The positive rate of mNGS was higher than that of blood culture,and the difference was statistically signifi cant(P<0.05).The accuracy of mNGS was lower than that of blood culture②The mean values of ESR,PCT and CRP in positive group were higher than those in negative group,and the proportion of septic shock was higher than that in negative group,and the differences were statistically signifi cant(P<0.05).There was no signifi cant difference in 28-day mortality rate between the two groups(P>0.05).Conclusions mNGS is benefi cial to the etiological diagnosis and treatment of bloodstream infection in patients with sepsis.