ICU内脓毒症患者应用宏基因组二代测序的临床分析

doi:10.3969/j.issn.1002-1949.2019.05.004

Chinese Journal of Critical Care Medicine

2019, Vol. 39

Issue (5): 416-420 DOI: 10.3969/j.issn.1002-1949.2019.05.004

Clinical analysis of metagenomics next generation sequencing in the sepsis patients in Intensive Care Unit

Tian Li-jun, Cao Zhi-long, Huang Xiao-ying, Han Xu-dong

Department of Intensive Care Unit, Nantong Third People′s Hospital, Nantong 226000, China

Abstract
Figure/Table
References (17)
Related Citation (15)

Download: PDF (1888 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To investigate the effects of metagenomics next generation sequencing (mNGS) on the treatment and prognosis of the patients with sepsis in Intensive Care Unit (ICU). Methods We performed a retrospective analysis of the patients with sepsis who had a mNGS report admitted to ICU according with the enrollment condition from September 2017 to December 2018. The records included the general clinical data, mNGS reports, and clinical microbiology reports before and after the mNGS. We evaluated the consistency of the mNGS with the clinical microbiology reports and clinical judgment. The healing change after the mNGS and the adjustment effect were also recorded. Results During the study period, a total of 20 patients with an average age of (58.15±17.30) years old submitted the mNGS. The acute physiology and chronic health evaluation II (APACHE Ⅱ) score of these patients admitted to ICU was (23.00±9.48), and the sequential organ failure assessment (SOFA) score before submitting the mNGS was 5 (4～11). The ICU mortality rate and the 28-day in-hospital mortality was 45% and 60%, respectively. A total of 22 samples were obtained from 20 patients, including 12 blood specimens, 4 BALF specimens, 3 sputum specimens, 2 CSF specimens and 1 ascites specimen. The proportion of viruses, gram-negative bacteria, gram-positive bacteria, fungus and tuberculous bacillus detected in the 20 patients was 11、9、3、6 and 1, respectively. The positive rate of mNGS was significantly higher than traditional microbiological assay (19vs. 8, P＜0.01). Compared with clinical judgment, the coincidence rate with mNGS was also significantly higher than the traditional microbiological assay (18 vs. 7, P＜0.01). According to the results of mNGS, the treatment was adjusted in 14 patients, and the clinical symptoms were improved in 9 patients. Conclusion The use of mNGS in the patients with sepsis in the ICU can improve the positive rate of pathogen detection and effectively guide treatment, which may improve the prognosis.

Key words： Metagenomics next generation sequencing (mNGS) Sepsis Intensive care unit (ICU)

Corresponding Authors: Han Xu-dong, E-mail: hanxudong9610@163.com

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Tian Li-jun
	Cao Zhi-long
	Huang Xiao-ying
	Han Xu-dong

Cite this article:

Tian Li-jun,Cao Zhi-long,Huang Xiao-ying, et al. Clinical analysis of metagenomics next generation sequencing in the sepsis patients in Intensive Care Unit[J]. Chinese Journal of Critical Care Medicine, 2019, 39(5): 416-420.

URL:

http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2019.05.004 OR http://www.cnemergency.org.cn/EN/Y2019/V39/I5/416

［1］贺小丽, 李德渊, 乔莉娜, 等. 脓毒症流行病学及预后的研究进展［J］. 中华危重病急救医学, 2018, 30(5) :486-489. ［2］Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016［J］. Intensive Care Med, 2017, 43(3):304-377. ［3］Deurenberg RH, Bathoorn E, Chlebowicz MA, et al. Application of next generation sequencing in clinical microbiology and infection prevention［J］. J Biotechnol, 2017, 243:16-24. ［4］张敏, 李伯安, 邱广斌. 下一代测序技术在感染性疾病检测上的临床应用［J］. 中华检验医学杂志, 2017, 40(7) :492-494. ［5］Long Y, Zhang Y, Gong Y, et al. Diagnosis of sepsis with cell-free DNA by next-generation sequencing technology in ICU patients［J］. Arch Med Res, 2016, 47(5):365-371. ［6］Brenner T, Decker SO, Grumaz S, et al. Next-generation sequencing diagnostics of bacteremia in sepsis (Next GeneSiS-Trial): study protocol of a prospective, observational, noninterventional, multicenter, clinical trial［J］. Medicine (Baltimore), 2018, 97(6):e9868. ［7］Grumaz S, Stevens P, Grumaz C, et al. Next-generation sequencing diagnostics of bacteremia in septic patients［J］. Genome Med, 2016, 8(1):73. ［8］Seymour CW, Gesten F, Prescott HC, et al. Time to treatment and mortality during mandated emergency care for sepsis［J］. N Engl J Med, 2017, 376(23):2235-2244. ［9］Simner PJ, Miller S, Carroll KC. Understanding the promises and hurdles of metagenomic next-generation sequencing as a diagnostic tool for infectious diseases［J］. Clin Infect Dis, 2018, 66(5):778-788. ［10］Chun K, Syndergaard C, Damas C, et al. Sepsis pathogen identification［J］. J Lab Autom, 2015, 20(5):539-561. ［11］van de Groep K, Bos MP, PHM S, et al. Development and first evaluation of a novel multiplex real-time PCR on whole blood samples for rapid pathogen identification in critically ill patients with sepsis［J］. Eur J Clin Microbiol Infect Dis, 2018, 37(7):1333-1344. ［12］Walton AH, Muenzer JT, Rasche D, et al. Reactivation of multiple viruses in patients with sepsis［J］. PLoS One, 2014, 9(2):e98819. ［13］Ong DSY, Bonten MJM, Spitoni C, et al. Epidemiology of multiple herpes viremia in previously immunocompetent patients with septic shock［J］. Clin Infect Dis, 2017, 64(9):1204-1210. ［14］Li X, Huang Y, Xu Z, et al. Cytomegalovirus infection and outcome in immunocompetent patients in the intensive care unit: a systematic review and meta-analysis［J］. BMC Infect Dis, 2018, 18(1):289. ［15］朱逸敏, 张文宏. 二代测序在脓毒血症患者病原学诊断中的应用［J］. 微生物与感染, 2018, 13(2):97-101. ［16］Hernaez R, Solà E, Moreau R, et al. Acute-on-chronic liver failure: an update［J］. Gut, 2017, 66(3):541-553. ［17］Somasekar S, Lee D, Rule J, et al. Viral surveillance in serum samples from patients with acute liver failure by metagenomic next-generation sequencing［J］. Clin Infect Dis, 2017, 65(9):1477-1485.