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Multicenter Study
. 2023 Sep 13:13:1251509.
doi: 10.3389/fcimb.2023.1251509. eCollection 2023.

Diagnostic efficiency of metagenomic next-generation sequencing for suspected infection in allogeneic hematopoietic stem cell transplantation recipients

Jiayu Huang  1   2 , Yeqian Zhao  3 , Chuanhe Jiang  1   2 , Dongsheng Han  4 , Zengkai Pan  1   2 , Zilu Zhang  1   2 , Luxiang Wang  1   2 , Wei Chen  5   6 , Su Li  7 , Yanmin Zhao  3 , Xiaoxia Hu  1   2
Affiliations
Multicenter Study

Diagnostic efficiency of metagenomic next-generation sequencing for suspected infection in allogeneic hematopoietic stem cell transplantation recipients

Jiayu Huang et al. Front Cell Infect Microbiol. .

Abstract

Introduction: Immunosuppression predisposes allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients to infection. Prompt and accurate identification of pathogens is crucial to optimize treatment strategies. This multi-center retrospective study aimed to assess the ability of metagenomic next-generation sequencing (mNGS) to detect causative pathogens in febrile allo-HSCT recipients and examined its concordance with conventional microbiological tests (CMT).

Methods: We performed mNGS and CMT on samples obtained from 153 patients with suspected infection during allo-HSCT. Patients were grouped based on their neutropenic status at the time of sampling.

Results: The mNGS test was more sensitive than CMT (81.1% vs. 53.6%, P<0.001) for diagnosing clinically suspected infection, especially in the non-neutropenia cohort. mNGS could detect fungi and viruses better than bacteria, with a higher sensitivity than CMT. Immune events were diagnosed in 57.4% (35/61) of the febrile events with negative mNGS results, and 33.5% (48/143) with negative CMT results (P=0.002). The treatment success rate of the targeted anti-infection strategy was significantly higher when based on mNGS than on empirical antibiotics (85% vs. 56.5%, P=0.004).

Conclusion: The mNGS test is superior to CMT for identifying clinically relevant pathogens, and provides valuable information for anti-infection strategies in allo-HSCT recipients. Additionally, attention should be paid to immune events in patients with negative mNGS results.

Keywords: clinical infection; conventional microbiological tests; diagnostic efficiency; immune events; metagenomic next-generation sequencing.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Comparison of detection sensitivities of the specific pathogens with mNGS and CMT in two cohorts. (A) Total specimens (B) Blood specimen. * P<0.05 *** P<0.001.
Figure 3
Figure 3
Summary of the relationship between mNGS and CMT results in cohort A (A) and cohort B (B). Cohort A: neutropenia; Cohort B: non-neutropenia.
Figure 4
Figure 4
CMV detection and clinically significant CMV infection in different time periods after allo-HSCT.
See this image and copyright information in PMC

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