宏基因组二代测序在鲍曼不动杆菌肺炎混合感染者诊疗中的应用  

Application value of metagenomic next-generation sequencing for the diagnosis and treatment of patients with Acinetobacter baumannii pneumonia mixed infection

作　　者：孙国先 蔡萍 刘微丽 孟丽君 侯红玲 Sun Guoxian;Cai Ping;Liu Weili;Meng Lijun;Hou Hongling(Department of Clinical Pharmacy,Affiliated Hospital of Yangzhou University,Yangzhou 225001,China;Department of Critical Care Unit,Affiliated Hospital of Yangzhou University,Yangzhou 225001,China;Department of Neurology,Affiliated Hospital of Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学附属医院临床药学科,扬州市225001 [2]扬州大学附属医院重症医学科,扬州市225001 [3]扬州大学附属医院神经内科,扬州市225001

出　　处：《中华实验和临床感染病杂志（电子版）》2022年第2期115-121,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：江苏省药学会-恒瑞药学服务专项科研资助项目(No.H202129);江苏省药学会-天晴医院药学科研项目(No.Q202050)。

摘　　要：目的探讨宏基因组二代测序(mNGS)技术对重症监护病房鲍曼不动杆菌肺炎混合感染者诊疗的应用价值。方法回顾性收集扬州大学附属医院2019年1月至2021年5月同时行肺泡灌洗液mNGS技术和传统病原检测的84例肺炎患者的基本资料、细菌培养以及mNGS检测结果、抗菌药物应用等。根据鲍曼不动杆菌感染的诊断标准和mNGS检测结果,将入组患者分为定植菌组(25例)、单一感染组(29例)和混合感染组(30例)。炎性指标、辛普森菌群多样性指数(SDI)、抗菌药物使用时间、使用强度、费用和总药费为正态分布的计量资料,采用t检验或ANOVA检验分析;患者年龄分布、基础疾病、发热时间分布、不同临床疗效和治疗转归占比均采用[例(%)]表示,组间比较采用卡方检验。结果入组的84例患者传统病原和mNGS检测鲍曼不动杆菌均为阳性,其中25例鲍曼不动杆菌定植和59例鲍曼不动杆菌肺炎患者;男性44例、女性40例,年龄[65.4(62,68)]岁。mNGS检测中,30例[50.85%(30/59)]检出混合感染;传统病原检测中,3例[5.08%(3/59)]检出混合感染,显著低于mNGS检测,差异有统计学意义(χ^(2)=30.667、P<0.001)。mNGS检出混合感染居前3位的病原体分别为人疱疹病毒(7例)、肺炎链球菌(5例)和耶氏肺孢子虫(5例)。定植菌组、单一感染组和混合感染组患者SDI分别为(0.77±0.11)、(0.38±0.16)和(0.34±0.17),差异具有统计学意义(F=65.411、P<0.001)。单一感染组与混合感染组患者白细胞计数(t=2.211、P=0.031)、中性粒细胞比率(t=2.068、P=0.043)、C-反应蛋白(t=2.024、P=0.048)、抗菌药物费用(t=2.279、P=0.026)、抗菌药物使用强度(t=2.161、P=0.035)、住院天数(t=2.664、P=0.010)、总药费(t=2.397、P=0.020)和体温降至正常时间(t=-2.178、P=0.034)差异均有统计学意义。单一感染组患者治疗显效率高于混合感染组(82.76%vs.56.67%,χ^(2)=4.735、P=0.047)。结论肺泡灌洗液mNGS技术在检测鲍Objective To investigate the application value of metagenomic next-generation sequencing(mNGS)technology for the diagnosis and treatment of patients with Acinetobacter baumannii(Ab)pneumonia mixed infection in intensive care units(ICU).Methods The basic data,bacterial culture,mNGS test results and antimicrobial drug application of 84 patients who underwent both alveolar lavage fluid mNGS technique and traditional pathogen detection for pneumonia at the Affiliated Hospital of Yangzhou University from January 2019 to May 2021 were collected,retrospectively.All patients were divided into colonized bacteria group(25 cases),single infection group(29 cases)and mixed infection group(30 cases)according to the diagnostic criteria of Ab infection and mNGS test results.Data such as inflammatory indicators,the Simpson’s diversity index(SDI),time and intensity of antimicrobial drugs,and total drug costs were normally distributed and were analyzed by t-test or ANOVA test,and distribution of age,underlying disease,fever,different clinical efficacy and proportion of treatment conversion were count data and were analyzed byχ^(2) tests.Results Total of 84 patients were positive for traditional pathogen testing and mNGS testing,including 25 cases with Ab colonization and 59 cases with Ab pneumonia;44 males and 40 females,aging[65.4(62,68)]years old.During the mNGS test,30 cases[50.85%(30/59)]were with mixed infections;but only 3 cases[5.08%(3/59)]had mixed infections according to the traditional test,which was significantly lower than that of mNGS test(χ^(2)=30.667,P<0.001).The top three pathogens with mixed infections detected by mNGS were human herpes virus(7 cases),Streptococcus pneumoniae(5 cases)and Pneumocystis jiroveci(5 cases).The SDI were(0.77±0.11),(0.38±0.16)and(0.34±0.17)in colonized bacteria group,single infection group and mixed infection group,respectively,with significant difference(F=65.411,P<0.001).Compared with single infection group,white blood cell count[(11.56±1.34)×10^(9)/L vs.(10.61±1.91)×10^(9)/L

关 键 词：宏基因组二代测序 肺炎 支气管肺泡灌洗液 鲍曼不动杆菌 混合感染 

分 类 号：R446.5[医药卫生—诊断学]