Role of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing for diagnosis in focal pulmonary infectious diseases_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHI Baoyu ¹ , LI Yiheng ² , RUAN Ting ¹ , ZHANG Qin ¹ , XU Li ¹ ,  LI Ning ¹

1. Department of Pulmonary and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu 215002, P. R. China;
2. Class Two, Applied Statistics, Stony Brook Institute, Anhui University, Hefei, Anhui 230039, P. R. China;

Corresponding author：

LI Ning, Email: chopperzoro@126.com

Keywords：

Non-real-time ultrasonic bronchoscope; Metagenomic Next-Generation Sequencing (mNGS); focal pulmonary infection; bronchial alveolar lavage fluid

DOI：

10.7507/1671-6205.202206047

Video：

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Objective To study the application of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing (mNGS) for diagnosis in focal pulmonary infectious diseases. Methods Prospective inclusion of patients with focal pulmonary infection were randomly divided into two groups, the experimental group used non-real-time ultrasound bronchoscopy positioning to collect bronchial alveolar lavage fluid (BALF), while the control group used chest CT position. BALF was subjected to mNGS and traditional microbial detection including traditional culture, the fungal GM test and Xpert (MTB/RIF). Result The positive rate of traditional culture (39.58% vs. 16.67%, P=0.013) and mNGS (89.58% vs. 72.92%, P=0.036) in experimental group was higher. The positive rate of Xpert MTB/RIF (4.17% vs. 2.08%, P=1) and fungal GM test (6.25% vs. 4.17%, P=0.765) was similar. The positive rate of bacteria and fungi detected by mNGS was higher than traditional culture (61.46% vs. 28.13%, P<0.001). Mycobacterium tuberculosis was similar to Xpert MTB/RIF (8.33% vs. 3.13%, P=0.21). Aspergillus was similar to GM test (7.29% vs. 5.21%, P=0.77). The total positive rate of traditional microbial methods was 36.46%, but 81.25% in mNGS (P<0.001). mNGS showed that 35 cases were positive and 13 kinds of pathogens were detected in control group, but 43 patients and 17 kinds of pathogens were detected in experimental group. The average hospitalization time [(12.92±3.54) days vs. (16.35±7.49) days] and the cost [CNY (12209.17±3956.17) vs. CNY (19044.10±17350.85)] of experimental group was less (P<0.001). Conclusions Non-real-time ultrasound bronchoscopy combined with mNGS can improve the diagnostic rate of focal pulmonary infectious diseases which is worthy of popularization and application in clinical practice.

Citation： SHI Baoyu, LI Yiheng, RUAN Ting, ZHANG Qin, XU Li, LI Ning. Role of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing for diagnosis in focal pulmonary infectious diseases. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(10): 725-730. doi: 10.7507/1671-6205.202206047 Copy

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12.	温剑锋, 罗嘉韵, 廖卫平, 等. 经支气管内镜超声引导与经支气管镜下介入治疗支气管结核的临床对比. 中国现代药物应用, 2020, 14(15): 59-61.
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14.	Abdelghani R, Thakore S, Kaphle U, et al. Radial endobronchial ultrasound-guided transbronchial cryobiopsy. J Bronchology Interv Pulmonol, 2019, 26(4): 245-249.
15.	Li G, Huang J, Li Y, et al. The value of combined radial endobronchial ultrasound-guided transbronchial lung biopsy and metagenomic next-generation sequencing for peripheral pulmonary infectious lesions. Can Respir J, 2020, 2020: 2367505.
16.	Pallen MJ. Diagnostic metagenomics: potential applications to bacterial, viral and parasitic infections. Parasitology, 2014, 141(14): 1856-1862.
17.	徐智察, 赵冬冬, 周华, 等. 宏基因组测序在感染性疾病病原学诊断中的应用. 中华临床感染病杂志, 2019, 12(4): 302-308.
18.	Forbes JD, Knox NC, Ronholm J, et al. Metagenomics: the next culture-independent game changer. Front Microbiol, 2017, 8: 1069.
19.	中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版). 中华结核和呼吸杂志, 2018, 41(4): 255-280.
20.	Forbes JD, Knox NC, Peterson CL, et al. Highlighting clinical metagenomics for enhanced diagnostic decision-making: a step towards wider implementation. Comput Struct Biotechnol J, 2018, 16: 108-120.
21.	Brown JR, Bharucha T, Breuer J. Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases. J Infect, 2018, 76(3): 225-240.
22.	Chao LS, Li JH, Zhang YN, et al. Application of next generation sequencing-based rapid detection platform for microbiological diagnosis and drug resistance prediction in acute lower respiratory infection. Ann Transl Med, 2020, 8(24): 1644.
23.	Wang W, Ren DY, Xu CH, et al. Pulmonary actinomycosis diagnosed by radial endobronchial ultrasound coupled with metagenomic next-generation sequencing: a case report and brief literature review. Int J Infect Dis, 2020, 100: 379-381.
24.	Chen JH, Li YQ, Li ZZ, et al. Metagenomic next-generation sequencing identified Histoplasma capsulatum in the lung and epiglottis of a Chinese patient: a case report. Int J Infect Dis, 2020, 101: 33-37.

1. 黎毅敏. 肺部感染病原学流行病学的变迁给我们的提示. 中华重症医学电子杂志(网络版), 2016, 2(3): 167-170.
2. National Clinical Guideline Centre (UK). Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults. London: National Institute for Health and Care Excellence (UK), 2014, Dec. PMID: 25520986.
3. Strålin K. Usefulness of aetiological tests for guiding antibiotic therapy in community-acquired pneumonia. Int J Antimicrob Agents, 2008, 31(1): 3-11.
4. 王继灵, 杨莉, 陈国辉, 等. 新型经电子纤维支气管镜下防污染支气管肺泡灌洗、支气管肺泡灌洗以及常规痰检法在肺部感染诊治中的应用. 中华实验和临床感染病杂志(电子版), 2019, 13(3): 221-226.
5. Oki M, Saka H, Kitagawa C, et al. Endobronchial ultrasound-guided transbronchial biopsy using novel thin bronchoscope for diagnosis of peripheral pulmonary lesions. J Thorac Oncol, 2009, 4(10): 1274-1277.
6. Disayabutr S, Tscheikuna J, Nana A. The endobronchial ultrasound-guided transbronchial lung biopsy in peripheral pulmonary lesions. J Med Assoc Thai, 2010, 93 Suppl 1: S94-S101.
7. Eberhardt R, Anantham D, Ernst A, et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med, 2007, 176(1): 36-41.
8. Tsushima K, Sone S, Hanaoka T, et al. Comparison of bronchoscopic diagnosis for peripheral pulmonary nodule under fluoroscopic guidance with CT guidance. Respir Med, 2006, 100(4): 737-745.
9. Wilson MR, Sample HA, Zorn KC, et al. Clinical metagenomic sequencing for diagnosis of meningitis and encephalitis. N Engl J Med, 2019, 380(24): 2327-2340.
10. Gu W, Miller S, Chiu CY. Clinical metagenomic next-generation sequencing for pathogen detection. Annu Rev Pathol, 2019, 14: 319-338.
11. Jin XY, Yu JL, Yan J, et al. Diffuse miliary nodules in the bronchial mucosa observed by bronchoscopy: sarcoidosis or tuberculosis?. Clin Respir J, 2017, 11(1): 64-67.
12. 温剑锋, 罗嘉韵, 廖卫平, 等. 经支气管内镜超声引导与经支气管镜下介入治疗支气管结核的临床对比. 中国现代药物应用, 2020, 14(15): 59-61.
13. Chen A, Chenna P, Loiselle A, et al. Radial probe endobronchial ultrasound for peripheral pulmonary lesions. A 5-year institutional experience. Ann Am Thorac Soc, 2014, 11(4): 578-582.
14. Abdelghani R, Thakore S, Kaphle U, et al. Radial endobronchial ultrasound-guided transbronchial cryobiopsy. J Bronchology Interv Pulmonol, 2019, 26(4): 245-249.
15. Li G, Huang J, Li Y, et al. The value of combined radial endobronchial ultrasound-guided transbronchial lung biopsy and metagenomic next-generation sequencing for peripheral pulmonary infectious lesions. Can Respir J, 2020, 2020: 2367505.
16. Pallen MJ. Diagnostic metagenomics: potential applications to bacterial, viral and parasitic infections. Parasitology, 2014, 141(14): 1856-1862.
17. 徐智察, 赵冬冬, 周华, 等. 宏基因组测序在感染性疾病病原学诊断中的应用. 中华临床感染病杂志, 2019, 12(4): 302-308.
18. Forbes JD, Knox NC, Ronholm J, et al. Metagenomics: the next culture-independent game changer. Front Microbiol, 2017, 8: 1069.
19. 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版). 中华结核和呼吸杂志, 2018, 41(4): 255-280.
20. Forbes JD, Knox NC, Peterson CL, et al. Highlighting clinical metagenomics for enhanced diagnostic decision-making: a step towards wider implementation. Comput Struct Biotechnol J, 2018, 16: 108-120.
21. Brown JR, Bharucha T, Breuer J. Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases. J Infect, 2018, 76(3): 225-240.
22. Chao LS, Li JH, Zhang YN, et al. Application of next generation sequencing-based rapid detection platform for microbiological diagnosis and drug resistance prediction in acute lower respiratory infection. Ann Transl Med, 2020, 8(24): 1644.
23. Wang W, Ren DY, Xu CH, et al. Pulmonary actinomycosis diagnosed by radial endobronchial ultrasound coupled with metagenomic next-generation sequencing: a case report and brief literature review. Int J Infect Dis, 2020, 100: 379-381.
24. Chen JH, Li YQ, Li ZZ, et al. Metagenomic next-generation sequencing identified Histoplasma capsulatum in the lung and epiglottis of a Chinese patient: a case report. Int J Infect Dis, 2020, 101: 33-37.

Chinese Journal of Respiratory and Critical Care Medicine

Role of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing for diagnosis in focal pulmonary infectious diseases

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