The impact of the timing of mNGS-guided antibiotic adjustment on clinical outcomes in ICU patients with severe community-acquired pneumonia: a retrospective study.

IF 5.2 2区医学 Q1 MICROBIOLOGY

Annals of Clinical Microbiology and Antimicrobials Pub Date : 2026-01-18 DOI:10.1186/s12941-026-00848-5

Yong Sun, Kai Guo, Jing Tang, Junjie Zhao, Xiaojing Zhang, Youqin Yan, Lingmin Yuan, Yi Zhang, Canhu Qiu, Jian Luo, Juan Chen, Honglong Fang

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Abstract

Background: Severe community-acquired pneumonia (SCAP) remains a major cause of intensive care unit (ICU) admission and mortality. Prompt pathogen identification and timely administration of appropriate antimicrobial therapy are essential for improving patient outcomes. Although metagenomic next-generation sequencing (mNGS) enables rapid pathogen detection, the prognostic impact of the timing of mNGS-guided antibiotic adjustment remains unclear.

Methods: We conducted a multicenter retrospective study of ICU patients diagnosed with SCAP who underwent both bronchoalveolar lavage fluid (BALF) mNGS and conventional microbiological tests (CMTs). Patients were categorized into early (≤ 72 h) and late (> 72 h) antibiotic adjustment groups based on the interval from ICU admission to the time of antibiotic adjustment guided by mNGS results. Subgroup analyses were performed according to immune status.

Results: In our study, mNGS significantly outperformed conventional microbiological tests (CMTs) in pathogen detection (92.70% vs. 57.18%, P < 0.001), with a particularly higher yield for mixed infections (51.63% vs. 19.14%, P < 0.001). Early mNGS-guided antibiotic adjustment was associated with a significantly reduced 28-day mortality compared to late adjustment (41.98% vs. 53.76%, P = 0.037). Furthermore, multivariate logistic regression analysis confirmed early adjustment as an independent protective factor for 28-day mortality (adjusted OR = 0.44, 95% CI: 0.23-0.83, P = 0.011). In the immunocompromised subgroup, early mNGS-guided adjustment was associated with significantly lower 28-day mortality than late adjustment (39.29% vs. 60.00%, P = 0.029), with a significant interaction observed between timing and immune status (P = 0.042).

Conclusion: Early mNGS-guided antibiotic adjustment is associated with improved survival among ICU patients with SCAP. This benefit is more pronounced in immunocompromised patients, underscoring the importance of early mNGS application to guide antimicrobial decision-making in this vulnerable population.

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mngs引导下抗生素调整时机对重症社区获得性肺炎ICU患者临床结局的影响：一项回顾性研究

背景：严重社区获得性肺炎（SCAP）仍然是重症监护病房（ICU）入院和死亡的主要原因。及时鉴定病原体和及时给予适当的抗菌药物治疗对于改善患者预后至关重要。虽然新一代宏基因组测序（mNGS）能够快速检测病原体，但mNGS引导的抗生素调整时间对预后的影响仍不清楚。方法：我们对诊断为SCAP的ICU患者进行了多中心回顾性研究，这些患者接受了支气管肺泡灌洗液（BALF） mNGS和常规微生物试验（CMTs）。根据mNGS结果指导患者入院至抗生素调整时间的间隔，将患者分为早期（≤72 h）和晚期（≤72 h）抗生素调整组。根据免疫状态进行亚组分析。结果：在我们的研究中，mNGS在病原体检测方面明显优于传统微生物试验（cmt）（92.70% vs. 57.18%）。结论：早期mNGS引导的抗生素调整与SCAP ICU患者的生存率提高有关。这种益处在免疫功能低下患者中更为明显，强调了早期应用mNGS对指导这一脆弱人群的抗菌决策的重要性。

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

Annals of Clinical Microbiology and Antimicrobials MICROBIOLOGY-

CiteScore

8.60

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Annals of Clinical Microbiology and Antimicrobials considers good quality, novel and international research of more than regional relevance. Research must include epidemiological and/or clinical information about isolates, and the journal covers the clinical microbiology of bacteria, viruses and fungi, as well as antimicrobial treatment of infectious diseases. Annals of Clinical Microbiology and Antimicrobials is an open access, peer-reviewed journal focusing on information concerning clinical microbiology, infectious diseases and antimicrobials. The management of infectious disease is dependent on correct diagnosis and appropriate antimicrobial treatment, and with this in mind, the journal aims to improve the communication between laboratory and clinical science in the field of clinical microbiology and antimicrobial treatment. Furthermore, the journal has no restrictions on space or access; this ensures that the journal can reach the widest possible audience.