| Background and objective:Patients with hematological malignancies(HM)are prone to bloodstream infection when they have fever,which may even endanger the patient’s life in severe cases.Blood culture is the gold standard for the diagnosis of bloodstream infection,but it is time-consuming and labor-intensive,greatly affected by antibiotics,and has a low positive rate.Therefore,rapid and accurate detection of pathogenic microorganisms is urgently needed to achieve early diagnosis,guide treatment and improve prognosis.As an emerging high-throughput Sequencing technology,Metagenomic Next-Generation sequencing(mNGS)has the advantages of short detection cycle,wide detection range,high positive rate,and little influence of antibiotics in pathogen detection.The aim of this study is to compare the pathogen detection rate of mNGS and traditional blood culture in hematological malignancy patients with fever,analyze the bacterial spectrum,and explore the value of mNGS in the etiological diagnosis of hematological malignancy patients with fever.Methods:This study was a single-center retrospective analysis study.Patients with hematological malignancies who developed fever during hospitalization in the Department of Hematology of our hospital from May 2020 to September 2022 and received peripheral blood pathogen metagenomic next generation sequencing and blood culture after ineffective empirical anti-infective therapy were enrolled.The detection rates of bacteria and fungi were compared between mNGS and blood culture.The species,distribution and consistency of pathogens detected by different methods were analyzed.The patients with hematological malignancies were divided into the febrile neutropenic group(FN group)and the non-febrile neutropenic group(non-FN group)according to the neutrophil level,and the detection rates of mNGS on the pathogen of FN group and non-FN group were respectively analyzed.Results:A total of 204 eligible patients were collected in this study,including 114 males and 90 females,with an average age of(43.01 ± 14.77)years.The positive detection rate of mNGS for bacteria and fungi was higher than that of blood culture(42.16%vs 7.84%),and the difference was statistically significant(P=0.000).The positive detection rate of mNGS for bacteria was higher than that of blood culture(24.02%vs 6.37%).The common pathogenic bacteria were Klebsiella pneumoniae,Staphylococcus,Mycobacterium,Stenotrophomonas maltophilia,Pseudomonas aeruginosa and Enterococcus faecium.The positive detection rate of mNGS for fungi was higher than that of blood culture(24.02%vs 1.47%),and mNGS detected a total of 12 fungi.The most common pathogenic fungi were Candida,Aspergillus,Pneumocystis jirovecii,Rhizormycosis parvum and Klebsiella parvum.The positive detection rate of mNGS for viruses was higher than that of quantitative PCR(50.98%vs 14.71%),and the difference was statistically significant(P=0.000).A total of 10 viruses were detected by mNGS,and the common pathogenic viruses were cytomegalovirus,herpes virus and Epstein-Barr virus.The detection rate of pathogen in the FN group was higher than that in blood culture and quantitative PCR,and the detection rate of pathogen in the non-FN group was also higher than that in blood culture and quantitative PCR.Conclusion:The positive detection rate of mNGS for bacteria and fungi in hematological malignancy patients with fever was much higher than that of blood culture,and the difference was statistically significant.The positive detection rate of mNGS for viruses in hematological malignancy patients with fever was much higher than that of quantitative PCR,the difference was statistically significant.The application of mNGS detection can improve the detection rate of pathogen in hematological malignancy patients with fever,and the detection cycle is short,which can provide etiological evidence for clinical practice and guide the formulation of anti-infection treatment,and help to improve the treatment effect and prognosis of patients. |
PDF Full Text Request