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. 2024 Mar 19:14:1378112.
doi: 10.3389/fcimb.2024.1378112. eCollection 2024.

Combination of metagenomic next-generation sequencing and conventional tests unraveled pathogen profiles in infected patients undergoing allogeneic hematopoietic stem cell transplantation in Jilin Province of China

Hongyan Zou #  1 , Sujun Gao #  2 , Xiaoliang Liu  2 , Yong Liu  1 , Yunping Xiao  1 , Ao Li  1 , Yanfang Jiang  1
Affiliations

Combination of metagenomic next-generation sequencing and conventional tests unraveled pathogen profiles in infected patients undergoing allogeneic hematopoietic stem cell transplantation in Jilin Province of China

Hongyan Zou et al. Front Cell Infect Microbiol. .

Abstract

Background: Infection is the main cause of death for patients after allogeneic hematopoietic stem cell transplantation (HSCT). However, pathogen profiles still have not been reported in detail due to their heterogeneity caused by geographic region.

Objective: To evaluate the performance of metagenomic next-generation sequencing (mNGS) and summarize regional pathogen profiles of infected patients after HSCT.

Methods: From February 2021 to August 2022, 64 patients, admitted to the Department of Hematology of The First Hospital of Jilin University for HSCT and diagnosed as suspected infections, were retrospectively enrolled.

Results: A total of 38 patients were diagnosed as having infections, including bloodstream (n =17), pulmonary (n =16), central nervous system (CNS) (n =4), and chest (n =1) infections. Human betaherpesvirus 5 (CMV) was the most common pathogen in both bloodstream (n =10) and pulmonary (n =8) infections, while CNS (n =2) and chest (n =1) infections were mainly caused by Human gammaherpesvirus 4 (EBV). For bloodstream infection, Mycobacterium tuberculosis complex (n =3), Staphylococcus epidermidis (n =1), and Candida tropicalis (n =1) were also diagnosed as causative pathogens. Furthermore, mNGS combined with conventional tests can identify more causative pathogens with high sensitivity of 82.9% (95% CI 70.4-95.3%), and the total coincidence rate can reach up to 76.7% (95% CI 64.1-89.4%).

Conclusions: Our findings emphasized the importance of mNGS in diagnosing, managing, and ruling out infections, and an era of more rapid, independent, and impartial diagnosis of infections after HSCT can be expected.

Keywords: Jilin Province; MNGs; allogeneic hematopoietic stem cell transplantation; pathogen profiles; total coincidence rate.

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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 diagram.
Figure 2
Figure 2
Sample type (A) and infection site (B).
Figure 3
Figure 3
Causative pathogens in different systems. (A) Infection type in patients after HSCT. (B) Pathogen profiles causing bloodstream, chest, CNS, and pulmonary infections based on final clinical diagnoses.
Figure 4
Figure 4
Comparison between mNGS and CT in microbial detection using different samples. Differences in microbial detection between mNGS and CT using different samples. (A) all of samples. (B) blood sample. (C) BALF sample. (D) CSF sample. ‘CT’ represents conventional tests.
Figure 5
Figure 5
Performance comparison between mNGS and CT. I, Comparison of differences in detection between mNGS and CT. ‘N’ was the number of cases. ‘+’ and ‘-’ represent positive and negative results, respectively. II, Performance of mNGS (A), CT (B), and mNGS combined with CT (C) against final clinical diagnoses.
Figure 6
Figure 6
Semi-quantitative value of mNGS in the dynamic surveillance of infections. Case 1, CMV and EBV infections. Case 2, M.tuberculosis (MTB) infection. Case 3, CMV infection. Case 4, non-infection.
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