Metagenomic Next-Generation Sequencing for the Microbiological Diagnosis of Abdominal Sepsis Patients.

Hao Wang,Jiahui Zhang,Na Cui,Wei Cheng,Wei Gai,Dongkai Li

doi:10.3389/fmicb.2022.816631

Abstract

ObjectivesFor patients with intra-abdominal infection (IAI), the rapid and accurate identification of pathogens remains a challenge. Metagenomic next-generation sequencing (mNGS) is a novel technique for infectious diseases, but its application in IAI is limited. In this study, we compared the microbiological diagnostic ability of plasma mNGS with that of conventional peritoneal drainage (PD) culture in critical care settings.MethodsFrom January 2018 to December 2020, a prospective observational study was performed at a tertiary teaching hospital in China and data on 109 abdominal sepsis patients were collected. The pathogen detection performance of plasma mNGS and PD culture method were compared.Measurements and ResultsNinety-two positive cases detected on PD culture, while plasma mNGS detected 61 positive cases. Forty-five patients (44.0%) had at least one matched pair of plasma mNGS and PD culture results. Compared with PD culture, the plasma mNGS was more rapid (27.1 ± 4.0 vs. 68.9 ± 22.3 h, p < 0.05). The patients received initial antibiotic treatment matched with mNGS detection showed better clinical outcomes.ConclusionFor abdominal sepsis patients, plasma mNGS can provide early, noninvasive, and rapid microbiological diagnosis. Compared with conventional PD smear, culture, and blood culture methods, plasma mNGS promote the rapid detection of pathogenic bacteria.

Highlights

The abdomen cavity is the second most frequent source of sepsis and is associated with increased morbidity and mortality (Sartelli et al, 2014; Ross et al, 2018; Martin-Loeches et al, 2019; Sartelli, 2020), rapid diagnosis and initial treatment are necessary in clinical settings
For intra-abdominal infection (IAI), culturing peritoneal drainage (PD) fluid is a common method of identifying the pathogen (Mazuski et al, 2002; Tsuchiya et al, 2019; Thorndike and Kollef, 2020)
No significant differences were identified between the plasma metagenomic next-generation sequencing (mNGS) positive and negative groups in terms of age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, infection etiology, onset location, or comorbidities

Summary

Introduction

The abdomen cavity is the second most frequent source of sepsis and is associated with increased morbidity and mortality (Sartelli et al, 2014; Ross et al, 2018; Martin-Loeches et al, 2019; Sartelli, 2020), rapid diagnosis and initial treatment are necessary in clinical settings. Initial empirical antibiotic therapy is often non-specific, which may lead to unnecessary exposure to broad-spectrum antibiotics, and needs to be adjusted according to the microorganism profile as soon as possible (Mazuski et al, 2002; Thorndike and Kollef, 2020). For sepsis patients with negative cultures, the rapid and accurate identification of pathogens remains a challenge (Tsuchiya et al, 2019). For intra-abdominal infection (IAI), culturing peritoneal drainage (PD) fluid is a common method of identifying the pathogen (Mazuski et al, 2002; Tsuchiya et al, 2019; Thorndike and Kollef, 2020). This study was undertaken to compare the microbiological diagnostic ability of plasma mNGS with that of conventional peritoneal drainage culture for sepsis patients in critical care settings and to explore whether this promising and non-invasive tool for diagnosing infectious diseases can improve IAI care

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