The Clinicai Study About Metagenomic Nextgeneration Sequencing Technology’s Application Among Patients Diagnosed With Adult Community-Acquired Pneumonia And Failed In Initial Treatment

Objective: The purpose of this study was to analyze the distribution characteristics of pathogenic microorganisms and the infection types in the community-acquired pneumonia,CAP patients with initial treatment failure of metagenome next-generation sequencing,m NGS pathogen detection and traditional pathogen detection,and explored the clinical application value of m NGS pathogen detection in patients with CAP initial treatment failure.Methods: A total of 100 patients with CAP initial treatment failure who were hospitalized in the first ward of the Department of Respiratory and Critical Care Medicine of Handan Central Hospital were selected from January,2020 to June,2022 as the study participants and collected their basic information and pathogenic microorganism detection data.To analyze the distribution characteristics of pathogenic microorganisms and infection types in CAP patients with initial treatment failure;The differences between m NGS pathogen detection and traditional pathogen detection in pathogen type,pathogen detection positive rate and consistency with final clinical diagnosis;The effect of m NGS etiology detection on the adjustment of treatment plan;The difference in the positive rate of m NGS etiology detection among different specimen types.Results: 1.Distribution characteristics of clinical pathogens microorganisms among CAP patients with initial treatment failure: A total of 85 patients were diagnosed as final clinical pathogens,and 52 kinds of final clinical pathogenic microorganisms were detected.2.The distribution characteristics of infection types in CAP patients with initial treatment failure: A total of 13 infection types were detected,including 4 single infection types(37 cases,43.5%)and 9 mixed infection types(48 cases,56.5%).3.Comparison of the types and positive rates of pathogenic microorganisms: 89 pathogenic microorganisms were detected by m NGS pathogenic detection more than 23 pathogenic microorganisms detected by traditional pathogenic microorganism detection.The positive rate of m NGS pathogenic detection(89.0%)was higher than that of traditional pathogenic detection(60.0%),the difference was statistically significant(P < 0.001).4.Compared with the final clinical etiological diagnosis consistency: It showed that m NGS pathogen detection(75.0%)was significantly higher than traditional pathogen detection(28.0%),the difference was obviously significant(P < 0.001).5.The influence of m NGS pathogen detection on the adjustment of treatment regimen: The results showed that the effective rate of m NGS intervention group(87.1%)was greatly higher than that of m NGS non-intervention group(68.4%),the difference was obviously significant(P < 0.038).6.Comparison of the positive rate of m NGS pathogen detection in different specimen types: the results showed that the positive rate of bronchoalveolar lavage fluid specimens(96.6%)and the positive rate of sputum specimens(87.5%)were visibly higher than that of blood specimens(28.0%),the difference was statistically significant(P <0.001).The positive rate of bronchoalveolar lavage fluid samples was not visibly higher than that of sputum samples(P < 0.198).Conclusion: 1.There are various types of pathogenic microorganisms in patients with failed initial treatment of CAP,and the main type of infection is mixed infection,with bacteria infection + bacteria infection and bacteria infection + fungal infection being more common.2.m NGS pathogen detection is an effective means to improve the detection of pathogenic microorganisms,the final clinical diagnosis and treatment adjustment in CAP patients with initial treatment failure.3.Priority to specimen collection at the site of infection during m NGS pathogen detection can improve the positive rate of pathogenic microorganisms in patients with initial treatment failure of CAP.