Application of metagenomic next-generation sequencing in diagnosis and treatment of severe infection of hematological disorder_West China Medical Journal

Authors：

DENG Jiaowen ¹ , LI Yongli ¹ , LIU Qian ¹ , LI Zhiyuan ¹ , BIAN Tierong ² , HE Guangfeng ¹ , YUAN Kaifeng ¹ , LIN Fanli ¹ ,  XING Hongyun ¹

1. Department of Hematology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Medical Experimental Center, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

XING Hongyun, Email: xinghy52003@foxmail.com

Keywords：

Hematological disorder; infection; metagenomic next-generation sequencing; traditional method; clinical application

DOI：

10.7507/1002-0179.202205091

Video：

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Objective To explore the clinical value of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of severe and complex infection of malignant hematological disorder. Methods The mNGS test results, traditional etiology test results and general clinical data of inpatients with malignant hematological disorder in the Department of Hematology, the Affiliated Hospital of Southwest Medical University between June 2020 and February 2022 were retrospectively analyzed. To explore the clinical application value of mNGS in the diagnosis and treatment of severe complicated infection of hematological disorder. Results A total of 21 patients were included. The samples included 18 peripheral blood samples, 2 pleural fluid samples and 1 alveolar lavage fluid sample. In the included patients, through mNGS, pathogenic bacteria were directly detected in 17 patients, including 8 fungi, 9 bacteria and 10 viruses, of which 9 were mixed infections. The positive rate (81.0% vs. 33.3%, P=0.002), sensitivity (85.7% vs. 30.0%), granulocytopenia (9 vs. 3 cases, P=0.031) and the types of pathogen (Z=−3.416, P=0.001) detected by mNGS were all higher than those by traditional method. The infection control of 17 patients improved in varying degrees after adjusting the treatment plan according to the test results. Conclusions mNGS has significantly higher detection rate and sensitivity for bacteria, fungi, viruses and mixed infections. Compared with the traditional method, mNGS has more efficient characteristics. Its clinical application can further improve the diagnosis and treatment efficiency of severe complicated infection of malignant hematological disorder, and thus improve the survival rate of patients.

Citation： DENG Jiaowen, LI Yongli, LIU Qian, LI Zhiyuan, BIAN Tierong, HE Guangfeng, YUAN Kaifeng, LIN Fanli, XING Hongyun. Application of metagenomic next-generation sequencing in diagnosis and treatment of severe infection of hematological disorder. West China Medical Journal, 2022, 37(8): 1161-1165. doi: 10.7507/1002-0179.202205091 Copy

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11.	蔡素芳, 胡建达. 血液病患者继发侵袭性真菌病诊治的现状及进展. 临床血液学杂志, 2009, 22(7): 400-402.
12.	Ruhnke M, Böhme A, Buchheidt D, et al. Diagnosis of invasive fungal infections in hematology and oncology--guidelines of the Infectious Diseases Working Party (AGHIO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol, 2003, 82(Suppl 2): S141-148.
13.	Duan H, Li X, Mei A, et al. The diagnostic value of metagenomic next-generation sequencing in infectious diseases. BMC Infect Dis, 2021, 21(1): 62.
14.	Long Y, Zhang Y, Gong Y, et al. Diagnosis of sepsis with cell-free DNA by next-generation sequencing technology in ICU patients. Arch Med Res, 2016, 47(5): 365-371.
15.	Lee RA, Al Dhaheri F, Pollock NR, et al. Assessment of the clinical utility of plasma metagenomic next-generation sequencing in a pediatric hospital population. J Clin Microbiol, 2020, 58(7): e00419-20.
16.	Simner PJ, Miller S, Carroll KC, et al. Understanding the promises and hurdles of metagenomic next-generation sequencing as a diagnostic tool for infectious diseases. Clin Infect Dis, 2018, 66(5): 778-788.
17.	Luan Y, Hu H, Liu C, et al. A proof-of-concept study of an automated solution for clinical metagenomic next-generation sequencing. J Appl Microbiol, 2021, 131(2): 1007-1016.
18.	邓少丽, 陈鸣. 关注基因检测在临床实践中的伦理学问题. 中华检验医学杂志, 2016, 39(7): 481-483.
19.	中华医学会检验医学分会. 高通量宏基因组测序技术检测病原微生物的临床应用规范化专家共识. 中华检验医学杂志, 2020, 43(12): 1181-1195.

1. 宋晓超, 杨海飞, 陈凯, 等. 2013—2018 年恶性血液病患者血流感染病原菌与耐药性变迁. 中华医院感染学杂志, 2018, 28(11): 1641-1644, 1692.
2. Miao Q, Ma Y, Wang Q, et al. Microbiological diagnostic performance of metagenomic next-generation sequencing when applied to clinical Practice. Clin Infect Dis, 2018, 67(Suppl-2): S231-S240.
3. Lefterova MI, Suarez CJ, Banaei N, et al. Next-generation sequencing for infectious disease diagnosis and management: a report of the association for molecular pathology. J Mol Diagn, 2015, 17(6): 623-634.
4. Escrihuela-Vidal F, Laporte J, Albasanz-Puig A,et al. Update on the management of febrile neutropenia in hematologic patients. Rev Esp Quimioter, 2019, 32(Suppl 2): 55-58.
5. 闫晨华, 徐婷, 郑晓云, 等. 中国血液病患者中性粒细胞缺乏伴发热的多中心、前瞻性流行病学研究. 中华血液学杂志, 2016, 37(3): 177-182.
6. 胡付品, 郭燕, 朱德妹, 等. 2018 年 CHINET 中国细菌耐药性监测. 中国感染与化疗杂志, 2020, 20(1): 1-10.
7. Metan G, Demiraslan H, Kaynar LG, et al. Factors influencing the early mortality in haematological malignancy patients with nosocomial gram negative bacilli bacteraemia: a retrospective analysis of 154 cases. Braz J Infect Dis, 2013, 17(2): 143-149.
8. Averbuch D, Orasch C, Cordonnier C, et al. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on infections in leukemia. Haematologica, 2014, 99(2): 400.
9. Fenollar F, Raoult D. Molecular diagnosis of bloodstream infections caused by non-cultivable bacteria. Int J Antimicrob Agents, 2007, 30(Suppl 1): S7-S15.
10. 刘进. 侵袭性真菌病诊治进展. 现代实用医学, 2010, 22(5): 481-484.
11. 蔡素芳, 胡建达. 血液病患者继发侵袭性真菌病诊治的现状及进展. 临床血液学杂志, 2009, 22(7): 400-402.
12. Ruhnke M, Böhme A, Buchheidt D, et al. Diagnosis of invasive fungal infections in hematology and oncology--guidelines of the Infectious Diseases Working Party (AGHIO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol, 2003, 82(Suppl 2): S141-148.
13. Duan H, Li X, Mei A, et al. The diagnostic value of metagenomic next-generation sequencing in infectious diseases. BMC Infect Dis, 2021, 21(1): 62.
14. Long Y, Zhang Y, Gong Y, et al. Diagnosis of sepsis with cell-free DNA by next-generation sequencing technology in ICU patients. Arch Med Res, 2016, 47(5): 365-371.
15. Lee RA, Al Dhaheri F, Pollock NR, et al. Assessment of the clinical utility of plasma metagenomic next-generation sequencing in a pediatric hospital population. J Clin Microbiol, 2020, 58(7): e00419-20.
16. Simner PJ, Miller S, Carroll KC, et al. Understanding the promises and hurdles of metagenomic next-generation sequencing as a diagnostic tool for infectious diseases. Clin Infect Dis, 2018, 66(5): 778-788.
17. Luan Y, Hu H, Liu C, et al. A proof-of-concept study of an automated solution for clinical metagenomic next-generation sequencing. J Appl Microbiol, 2021, 131(2): 1007-1016.
18. 邓少丽, 陈鸣. 关注基因检测在临床实践中的伦理学问题. 中华检验医学杂志, 2016, 39(7): 481-483.
19. 中华医学会检验医学分会. 高通量宏基因组测序技术检测病原微生物的临床应用规范化专家共识. 中华检验医学杂志, 2020, 43(12): 1181-1195.

West China Medical Journal

Application of metagenomic next-generation sequencing in diagnosis and treatment of severe infection of hematological disorder

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