肺泡灌洗液mNGS检测神经外科重症下呼吸道感染病原的应用  

Application of pulmonary alveolar lavage fluid mNGS to detect pathogens of severe lower respiratory tract infection in neurosurgery

作　　者：杨帆[1] 李冰[2] 张辉[3] 陈劲松[4] YANG Fan;Li Bing;ZHANG Hui;CHEN Jinsong(Neurosurgery ICU,Henan Provincial People's Hospital,Zhengzhou,Henan,China,450003;Depart-ment of Neurosurgery,the First People's Hospital of Shangqiu,Shangqiu,Henan,China,476000;ICU of the First People's Hospital of Shangqiu,Shangqiu,Henan,China,476000;ICU,Huangchuan People's Hospital,Xinyang,Henan,China,465150)

机构地区：[1]河南省人民医院神经外科ICU,河南郑州450003 [2]商丘市第一人民医院神经外科,河南商丘476000 [3]商丘市第一人民医院ICU,河南商丘476000 [4]潢川县人民医院ICU,河南信阳465150

出　　处：《分子诊断与治疗杂志》2024年第5期830-833,838,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河南省卫生健康委省部共建青年项目(SBGJ202003008)。

摘　　要：目的分析宏基因二代测序(mNGS)技术对神经外科重症下呼吸道感染患者肺泡灌洗液中病原体和肺炎克雷伯菌耐药基因检测。方法选取2020年6月至2022年6月河南省人民医院收治的196例神经外科重症下呼吸道感染患者作为研究对象。采集患者的肺泡灌洗液标本进行常规病原学与mNGS技术检测,对病原体进行分离鉴定,并计算2种检测方法的差异性;并检测肺炎克雷伯菌的耐药基因与药敏试验结果。结果常规病原学检测的阳性率为62.42%(122/196),mNGS技术检测阳性率为88.27%(173/196),mNGS技术检测高于常规病原学检测(χ^(2)=35.631,P<0.05);肺炎克雷伯菌经mNGS技术检出耐药基因包括超广谱β-内酰胺酶基因(SHV、TEM)与碳青霉烯酶基因(KPC);药敏试验结果显示,肺炎克雷伯菌对头孢唑林、头孢呋辛及头孢曲松的耐药率较高,分别为75.00%、66.67%及54.17%,对比阿培南及美罗培南的耐药率较低,分别为16.67%及12.50%。结论mNGS技术能够有效提高神经外科重症下呼吸道感染阳性检出率,可辅助评估肺炎克雷伯菌抗菌药物耐药性基因。Objective To analyze the detection of pathogens and Klebsiella pneumoniae resis⁃tance genes in alveolar lavage fluid of patients with severe lower respiratory tract infection in neurosurgery us⁃ing metagenomic next generation sequencing(mNGS).Methods A total of 196 patients with severe lower re⁃spiratory tract infections in the Department of neurosurgery were admitted to Henan Provincial People's Hospi⁃tal from June 2020 to June 2022 and were retrospectively selected as the study subjects.Alveolar lavage fluid samples were collected from these patients for routine etiological and mNGS detection.Pathogens were isolated and identified,and the differences between the two detection methods were calculated.The drug resistance gene and drug susceptibility tests of Klebsiella pneumoniae were also detected.Results The positive rate of conventional etiology detection was 62.42%(122/196),while that of mNGS detection was 88.27%(173/196)(χ^(2)=35.631,P<0.05).Resistance genes of Klebsiella pneumoniae were detectedusing the mNGS technique,including ultra⁃broad spectrumβ⁃lactamase genes(SHV,TEM)and carbapenemase genes(KPC).Results from drug susceptibility tests showed that the resistance rates of Klebsiella pneumoniae to cefzorim,cefurox⁃ime and ceftriaxone were 75.00%,66.67%and 54.17%,respectively.The resistance rates to biapenem and me⁃ropenem were 16.67%and 12.50%,respectively.Conclusion The mNGS technique can effectively improve the positive detection rate of severe lower respiratory tract infections in neurosurgery.It can also assist in evalu⁃ating antimicrobial resistance genes of Klebsiella pneumoniae.

关 键 词：下呼吸道感染 宏基因二代测序 肺泡灌洗液 肺炎克雷伯菌 耐药基因 

分 类 号：R446.5[医药卫生—诊断学] R741[医药卫生—临床医学]