Introduction
Pulmonary infections remain a significant global health challenge, with high mortality rates despite advancements in microbiological testing and medical treatments. Rapid and accurate diagnosis is crucial for effective management and prevention of drug-resistant bacteria. Traditional microbial culture methods, while effective, have limitations such as low positive rates and lengthy turnaround times. Recent advancements in diagnostic techniques, including metagenomic next-generation sequencing (mNGS), offer promising solutions.
Objectives
This study aims to evaluate the practical utility of bronchoalveolar lavage fluid (BALF) mNGS in the clinical management of patients with suspected pneumonia. By comparing mNGS with conventional microbial tests (CMTs), the study seeks to determine the effectiveness of mNGS in diagnosing pulmonary infections and guiding treatment decisions.
Methods
A retrospective analysis was conducted on 296 patients who underwent BALF mNGS and CMTs for suspected pneumonia. The study compared clinical characteristics between patients with pulmonary infection (PI) and those without (NPI). Detection rates of mNGS and CMTs were analyzed across different patient groups, with results visualized using a Sankey diagram.
Results
The study found that patients with fever, malignant tumors, chest CT abnormalities, and elevated inflammatory markers were more likely to develop lung infections. mNGS demonstrated a significantly higher positive detection rate compared to CMTs in patients with pulmonary infections (87.95% vs. 71.06%, p<0.001), immunocompetent patients (86.91% vs. 68.08%, p<0.001), and patients with malignant tumors (92.31% vs. 69.23%, p=0.035). mNGS also facilitated appropriate antibiotic treatment and confirmed empirical treatment effectiveness. In immunocompromised patients, mNGS yielded higher rates of accurate diagnosis and effective treatment compared to immunocompetent patients.
Discussion
mNGS offers several advantages over traditional methods, including the ability to detect a wide range of pathogens quickly and accurately. It is particularly beneficial for diagnosing rare and emerging pathogens and in cases where traditional culture methods are time-consuming or ineffective. However, challenges remain in the clinical application of mNGS, such as the lack of standardized protocols and high costs.
Clinical Implications
The study highlights the potential of mNGS to improve the diagnosis and management of pulmonary infections, especially in immunocompromised patients. By providing rapid and comprehensive pathogen identification, mNGS can guide targeted therapy and improve patient outcomes. Despite its higher initial cost, mNGS may reduce overall healthcare costs by enabling timely and appropriate treatment.
Conclusion
BALF mNGS is a valuable tool for diagnosing pulmonary infections, offering higher detection rates and sensitivity compared to CMTs. Its application in clinical practice can enhance the management of suspected pneumonia, particularly in complex cases involving immunocompromised patients. Further research is needed to optimize mNGS protocols and assess its cost-effectiveness in broader clinical settings.
🔗 **Fuente:** https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2025.1521641/full