Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-05-19 DOI:10.1016/j.jiph.2025.102831

Jin-zhu Wang , Jiang-bo Wang , Ding Yuan , Chang-hua Sun , Lin-lin Hou , Yan Zhang , Xiang-hong Yang , Hong-xiang Xie , Yan-xia Gao

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引用次数: 0

Abstract

Background

Pneumocystis jirovecii pneumonia (PJP), caused by Pneumocystis jirovecii (PJ), is an opportunistic infection prevalent in clinical settings. However, large-scale studies on the efficacy of metagenomic next-generation sequencing (mNGS)-based diagnosis of PJP in patients without human immunodeficiency virus infection (HIV) are lacking.

Methods

The study included 168 patients diagnosed with either PJP (84) or other pneumonia types (non-PJP patients; 84) who underwent mNGS-mediated bronchoalveolar lavage fluid (BALF) analysis, Gomori methenamine silver (GMS) staining and peripheral blood 1,3-beta-D-glucan (BDG) testing. Additionally, patients with PJP were categorized into survival (n = 55) and non-survival (n = 29) groups based on a 28-day in-hospital outcome to compare clinical characteristics, inflammatory markers, PJ sequence counts in BALF, and serum BDG levels.

Results

Serum BDG levels, the proportion of patients with serum BDG of > 60 pg/mL and > 200 pg/mL were notably higher in the PJP group compared with that in the non-PJP group (all P< 0.05). The sensitivity and specificity of mNGS in diagnosing PJP were higher than those of serum BDG testing (sensitivity: 100 % vs. 63.0 %; specificity: 96.4 % vs. 90.4 %; both P< 0.05). The most common coinfection was viral (30.9 %), followed by bacterial–viral coinfections (13.0 %). Treatment regimens were altered for 83.3 % of patients based on the mNGS results. The patients in the non-survival group showed markedly higher serum BDG levels (142.5 [32.7, 277.7] vs. 123.0 [34.0, 164.0]) and a higher proportion of PJ sequence counts of > 1 × 10⁵ (13.7 % vs. 0, P= 0.005) relative to those in the survival group.

Conclusion

The mNGS showed superior performance over serum BDG testing and GMS staining in diagnosing PJP in non-HIV patients and identified a broader range of coinfections.

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无人类免疫缺陷病毒感染的患者中基于新一代测序的诊断：一项双中心回顾性倾向匹配研究

基氏肺囊虫肺炎（PJP）是由基氏肺囊虫（PJ）引起的一种常见的机会性感染。然而，基于宏基因组新一代测序（mNGS）的PJP诊断在非人类免疫缺陷病毒感染（HIV）患者中的有效性的大规模研究缺乏。方法本研究纳入168例诊断为PJP（84例）或其他类型肺炎(非PJP患者；84)接受了mngs介导的支气管肺泡灌洗液（BALF）分析、Gomori甲基胺银（GMS）染色和外周血1,3- β - d -葡聚糖（BDG）检测。此外，根据住院28天的结果，将PJP患者分为生存组（n = 55）和非生存组（n = 29），以比较临床特征、炎症标志物、BALF中PJ序列计数和血清BDG水平。结果PJP组血清BDG水平、血清BDG为>； 60 pg/mL和>； 200 pg/mL的患者比例明显高于非PJP组(均为P<；0.05)。mNGS诊断PJP的敏感性和特异性均高于血清BDG检测(敏感性：100 % vs. 63.0 %；特异性：96.4 % vs. 90.4 %；术中;0.05)。最常见的共感染是病毒（30.9 %），其次是细菌-病毒共感染（13.0 %）。根据mNGS结果，83.3 %的患者改变了治疗方案。非生存组患者血清BDG水平明显高于生存组（142.5[32.7,277.7]比123.0 [34.0,164.0]），PJ序列计数>； 1 × 105的比例（13.7 %比0，P= 0.005）高于生存组。结论mNGS在诊断非hiv患者PJP方面优于血清BDG检测和GMS染色，可识别更广泛的合并感染。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.