Infection and Drug Resistance (Jul 2024)
Metagenomic Next-Generation Sequencing for Accurate Diagnosis of Pneumocystis jirovecii Pneumonia: A Comparative Study with Traditional Methods
Abstract
Wentao Luo,1 Xiuwen Lin,1 Yuchong Chen,2 Wenfeng Luo,3 Huagen Zhang1 1The Third Department of Critical Care Medicine, Meizhou People’s Hospital, Meizhou, Guangdong, 514000, People’s Republic of China; 2The Fourth Department of Critical Care Medicine, Meizhou People’s Hospital, Meizhou, Guangdong, 514000 People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, Meizhou People’s Hospital, Meizhou, Guangdong, 514000, People’s Republic of ChinaCorrespondence: Huagen Zhang, The Third Department of Critical Care Medicine, Meizhou People’s Hospital, Meizhou, Guangdong, 514000, People’s Republic of China, Tel +8613549175546, Email [email protected]: Metagenomic next-generation sequencing (mNGS) is a high-throughput sequencing technique that identifies a wide array of pathogens directly from clinical specimens. This study evaluates the diagnostic value of mNGS in Pneumocystis jirovecii pneumonia (PJP) and compares its efficacy with traditional detection methods, including Grocott’s Methenamine Silver (GMS) staining, serum (1– 3)-β-D-Glucan (BDG) testing, and Lactate Dehydrogenase (LDH) testing.Methods: Seventy-eight patients hospitalized between January 2022 and March 2023 with suspected pulmonary infections were included. Patients were eligible for mNGS if they exhibited symptoms such as fever, cough, dyspnea, or progressive hypoxemia, and met specific clinical criteria for PJP. Specimens obtained included bronchoalveolar lavage fluid, sputum, and peripheral blood. Positive rates and pathogen distributions detected by mNGS and traditional methods were compared.Results: In the PJP group, 25%, 37.5%, and 9.38% of patients had solid organ tumors, corticosteroid use, and skin diseases, respectively, significantly higher than in the non-PJP group. The sensitivity and specificity of mNGS were both 100%, significantly higher than those of serum BDG (sensitivity 50%, specificity 81.8%) and LDH (sensitivity 9.3%, specificity 91.3%). Significant differences in microbial composition between the PJP and Non-PJP groups were observed. mNGS detected multiple mixed pathogens in 96.88% of PJP cases, with 68.75% exhibiting mixed bacterial and viral infections. Notably, 71% of patients improved following antibacterial treatment based on mNGS results.Conclusion: mNGS technology shows superior sensitivity and specificity in diagnosing PJP and guides precise treatment for complex pulmonary infections.Keywords: mNGS, Pneumocystis jirovecii pneumonia, pulmonary infections, dominant pathogens, sensitivity
