Utility of paired plasma and drainage fluid mNGS in diagnosing acute intra-abdominal infections with sepsis

Abstract

Background: Metagenomic next-generation sequencing (mNGS) has been increasingly applied in sepsis. We aimed to evaluate the diagnostic and therapeutic utility of mNGS of paired plasma and peritoneal drainage (PD) fluid samples in comparison to culture-based microbiological tests (CMTs) among critically ill patients with suspected acute intra-abdominal infections (IAIs).

Methods: We conducted a prospective study from October 2021 to December 2022 enrolling septic patients with suspected IAIs (n = 111). Pairwise CMTs and mNGS of plasma and PD fluid were sent for pathogen detection. The mNGS group underwent therapeutic regimen adjustment based on mNGS results for better treatment. The microbial community structure, clinical features, antibiotic use and prognoses of the patients were analyzed.

Results: Higher positivity rates were observed with mNGS versus CMTs for both PD fluid (90.0% vs. 48.3%, p < 0.005) and plasma (76.7% vs. 1.6%, p < 0.005). 90% of enrolled patients had clues of suspected pathogens combining mNGS and CMT methods. Gram-negative pathogens consist of most intra-abdominal pathogens, including a great variety of anaerobes represented by Bacteroides and Clostridium. Patients with matched plasma- and PD-mNGS results had higher mortality and sepsis severity. Reduced usage of carbapenem (30.0% vs. 49.4%, p < 0.05) and duration of anti-MRSA treatment (5.1 ± 3.3 vs. 7.0 ± 8.4 days, p < 0.05) was shown in the mNGS group in our study.

Conclusions: Pairwise plasma and PD fluid mNGS improves microbiological diagnosis compared to CMTs for acute IAI. Combining plasma and PD mNGS could predict poor prognosis. mNGS may enable optimize empirical antibiotic use.

Keywords: Acute intra-abdominal infection; Antibiotics; Plasma and peritoneal drainage; Sepsis; mNGS.

Fig. 1

Flowchart showing step-by-step selection of patients included in the study

Fig. 2

Comparison of positive rate of different diagnostic methods in the study

Fig. 3

Distribution of positive and matched results of drainage fluid mNGS and CMT according to the detected pathogenic strains

Fig. 4

Distribution of positive and matched results of mNGS on plasma and drainage sample according to the detected pathogenic strains

Fig. 5

Comparison between the non-mNGS and mNGS groups on the empirical carbapenem, anti-MRSA and caspofungin usage. Left: Patients received the corresponding treatment. Right: Duration of the corresponding treatment. Y-axis, hour