摘要
目的探讨宏基因组二代测序技术(metagenomic next-generation sequencing,mNGS)在新生儿脓毒症病原诊断及对临床决策中的影响。方法回顾性选择2019年1月至2021年2月复旦大学附属上海市第五人民医院新生儿病房收治的疑似脓毒症、同时行mNGS及血培养检测的新生儿为研究对象,分析mNGS检出病原是否受抗菌药物影响及对临床治疗和管理的影响。结果共收治35例疑似脓毒症、同时行mNGS和血培养检查的患儿,确诊脓毒症24例,其中病原体阳性12例(mNGS+血培养阳性3例,仅mNGS阳性8例,仅血培养阳性1例),确诊脓毒症新生儿中mNGS病原检出率高于血培养检出率(45.8%比16.7%,P=0.049),mNGS和血培养一致性为74.3%。21例(60.0%)检测前使用过抗菌药物,14例未使用过抗菌药物,检测前是否使用抗菌药物mNGS和血培养的病原检出率差异均无统计学意义(19.0%(4/21)比4.8%(1/21),P=0.343;28.6%(4/14)比21.4%(3/14),P=1.000)。8.6%的患儿因mNGS结果调整了临床用药。结论mNGS可提高新生儿脓毒症病原检出率,与血培养有较好的一致性,值得应用于新生儿脓毒症临床诊疗。
Objective To study the clinical application of metagenomic next-generation sequencing(mNGS)on pathogen diagnosis and clinical management in neonatal sepsis.Methods From January 2019 to February 2021,neonates suspected of sepsis receiving both mNGS and blood culture in our hospital were retrospectively reviewed.The effects of mNGS on pathogen detection,antibiotic choice and clinical management were analyzed.Results A total of 35 neonates were included.Sepsis was confirmed in 24 neonates.12 neonates had positive microbiology results(both mNGS and blood culture were positive in 3 cases,only mNGS positive in 8 cases and only blood culture positive in 1 case).mNGS showed higher positive rate than blood culture in patients with neonatal sepsis(45.8%vs.16.7%,P=0.049).The concordance of mNGS and blood culture was 74.3%.21 cases(60.0%)had antibiotics before testing and the positive rate showed no significant difference between mNGS and blood culture[19.0%(4/21)vs.4.8%(1/21),P=0.343]in these patients.14 cases didn't receive antibiotics before testing and the positive rate also showed no significant difference between mNGS and blood culture[28.6%(4/14)vs.21.4%(3/14),P=1.000].8.6%patients changed clinical treatment based on the mNGS results.Conclusions mNGS increases pathogen detection in neonatal sepsis and is well consistent with blood culture.mNGS is useful in clinical practice.
作者
朱韵倩
甘明宇
张丽梅
吴冰冰
Zhu Yunqian;Gan Mingyu;Zhang Limei;Wu Bingbing(Department of Pediatrics,the Fifth People's Hospital of Shanghai,Fudan University,Shanghai 200240,China;Center for Molecular Medicine,Pediatric Research Institute,Children's Hospital of Fudan University,Shanghai 201102,China)
基金
上海市闵行区自然科学研究课题(2021MHZ057)。
关键词
脓毒症
婴儿
新生
宏基因组二代测序
Sepsis
Infant,newborn
Metagenomic next-generation sequencing
