Abstract

Rapid and reliable identification of bacterial pathogens directly from patient samples is required for optimizing antimicrobial therapy. Although Sanger sequencing of the 16S ribosomal RNA (rRNA) gene is used as a molecular method, species identification and discrimination is not always achievable for bacteria as their 16S rRNA genes have sometimes high sequence homology. Recently, next generation sequencing (NGS) of the 16S–23S rRNA encoding region has been proposed for reliable identification of pathogens directly from patient samples. However, data analysis is laborious and time-consuming and a database for the complete 16S–23S rRNA encoding region is not available. Therefore, a better, faster, and stronger approach is needed for NGS data analysis of the 16S–23S rRNA encoding region. We compared speed and diagnostic accuracy of different data analysis approaches: de novo assembly followed by Basic Local Alignment Search Tool (BLAST), operational taxonomic unit (OTU) clustering, or mapping using an in-house developed 16S–23S rRNA encoding region database for the identification of bacterial species. De novo assembly followed by BLAST using the in-house database was superior to the other methods, resulting in the shortest turnaround time (2 h and 5 min), approximately 2 h less than OTU clustering and 4.5 h less than mapping, and a sensitivity of 80%. Mapping was the slowest and most laborious data analysis approach with a sensitivity of 60%, whereas OTU clustering was the least laborious approach with 70% sensitivity. Although the in-house database requires more sequence entries to improve the sensitivity, the combination of de novo assembly and BLAST currently appears to be the optimal approach for data analysis.

Highlights

  • Clinical microbiology strives to improve patient care by rapidly identifying and characterizing microbial pathogens in patient samples to establish a correct diagnosis and to ensure optimal treatment and infection prevention

  • The main tool used for bacterial identification based on next generation sequencing (NGS) of the 16S–23S ribosomal RNA (rRNA) encoding region was de novo assembly followed by BLASTN on NCBI database (Sabat et al, 2017), there was no evidence that it would be the most accurate and/or fastest method available

  • The higher resolution at the species level identification provided by 16S–23S rRNA encoding region NGS makes its use in routine diagnostic microbiology potentially attractive

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Summary

Introduction

Clinical microbiology strives to improve patient care by rapidly identifying and characterizing microbial pathogens in patient samples to establish a correct diagnosis and to ensure optimal treatment and infection prevention. With the continuous advancements in sequencing technology over the past decade, next-generation sequencing (NGS) offers several advantages over Sanger sequencing, including a higher resolution and accuracy in identifying microbial pathogens (MacCannell, 2016; Motro and Moran-Gilad, 2017) This technology allows culture-independent testing from complex polymicrobial samples to detect and identify several pathogens in parallel (Rossen et al, 2018). A diagnostic method based on NGS of PCR amplification products of the 16S–23S rRNA encoding region (∼4.5 kb) has been developed (Benítez-Páez and Sanz, 2017; Kerkhof et al, 2017), showing a higher resolution and a reduced time to results for bacterial identification compared to other identification methods (e.g., 16S rRNA gene Sanger sequencing) (Sabat et al, 2017). This method had some limitations, including the absence of an extensive 16S–23S rRNA encoding region database and the lack of complementary software allowing easy and reliable species identification (Sabat et al, 2017)

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