mNGS-guided precision management of M. pneumoniae pneumonia: Pathogen load assessment and fungal co-detection patterns directing antibiotic optimization

IF 3.6 3区医学 Q1 MICROBIOLOGY

International Journal of Medical Microbiology Pub Date : 2026-06-01 Epub Date: 2026-01-31 DOI:10.1016/j.ijmm.2026.151699

Jiayin Li , Haiting Wei , Shuaifeng Wang , Yudie Cai , Ziyi Li , Yangmiao Zhang , Ang Li

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引用次数: 0

Abstract

Background

Global Mycoplasma pneumoniae pneumonia (MPP) outbreaks show increasing refractory cases. Conventional diagnostics lack sensitivity, with limited evidence on factors affecting M. pneumoniae load in mNGS, co-detected fungi, and antibiotic optimization.

Objective

To investigate the pivotal role of mNGS in optimizing the diagnosis and treatment of MPP.

Methods

We conducted a retrospective analysis of 305 patients with confirmed MPP. Among them, 74 patients (64 serum IgM-negative, 15 PCR-negative, 5 both negative) tested negative by traditional methods but were positive for M. pneumoniae via mNGS. Spearman correlation analysis evaluated associations between M. pneumoniae sequence counts (SC) and inflammation markers. Logistic regression identified risk factors for high SC. The spectrum of fungal co-detections was characterized through frequency statistics and association rule mining (Apriori algorithm). The association between antibiotic adjustment and clinical outcomes was assessed using the chi-square test.

Results

The mean age of the cohort was 27.92 ± 24.06 years. Common symptoms included cough (85.2 %) and fever (69.2 %). The median M. pneumoniae SC was 4.8 × 10⁴ ( 2.3 ×10 ³-2.6 ×10⁵). SC was significantly higher in the adolescent group (≤18 years) compared to the young adult group (18–45 years) (p = 0.007). Independent risk factors for high SC included fever (OR = 1.372 per 0.5°C increase), elevated serum lactate dehydrogenase level (OR = 1.005 per U/L increase), and decreased neutrophil percentage (OR = 0.969 per % decrease) (all p < 0.05). Fungal co-detection was identified in 23.9 % (73/305) of patients; predominant pathogens were Candida albicans (11.80 %), Aspergillus flavus (8.52 %), and Aspergillus fumigatus (8.52 %). The strongest co-occurrence association was observed between A. fumigatus and A. flavus (lift = 4.72, p < 0.001). Antibiotic adjustment was significantly associated with improved treatment effectiveness (OR = 5.33, p < 0.001).

Conclusion

Adolescents exhibit higher M. pneumoniae pathogen loads than young adults. Serum LDH levels and fever demonstrate positive correlations with pathogen load. A synergistic co-detection pattern between A. fumigatus and A. flavus was identified. mNGS, by integrating pathogen load quantification and co-detection profiling, effectively guides MPP diagnosis and antibiotic therapy, delivering pivotal evidence for precision treatment.

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mngs引导下肺炎支原体肺炎的精准管理：病原体负荷评估和真菌共同检测模式指导抗生素优化

全球肺炎支原体肺炎（MPP）暴发显示出越来越多的难治性病例。传统诊断缺乏敏感性，在影响mNGS中肺炎支原体负荷的因素、共同检测的真菌和抗生素优化方面的证据有限。目的探讨mgs在优化MPP诊断和治疗中的关键作用。方法对305例确诊的MPP患者进行回顾性分析。其中，74例患者（血清igm阴性64例，pcr阴性15例，双阴性5例）经传统方法检测为阴性，但经mNGS检测为肺炎支原体阳性。Spearman相关分析评估了肺炎支原体序列计数（SC）与炎症标志物之间的关系。通过频率统计和关联规则挖掘（Apriori算法）对真菌共检谱进行表征。使用卡方检验评估抗生素调整与临床结果之间的关系。结果患者平均年龄27.92岁 ± 24.06岁。常见症状包括咳嗽（85.2% %）和发烧（69.2% %）。肺炎支原体SC的中位数为4.8 × 10⁴（2.3 ×10 ³-2.6 ×10 5）。青少年组（≤18岁）的SC明显高于青壮年组（18 - 45岁）（p = 0.007）。高SC的独立危险因素包括发热（每升高0.5℃，OR = 1.372）、血清乳酸脱氢酶水平升高（每升高U/L， OR = 1.005）、中性粒细胞百分比降低（每降低%，OR = 0.969）（p均为 <； 0.05）。23.9 %（73/305）患者共检出真菌；优势病原菌为白色念珠菌（11.80 %）、黄曲霉（8.52 %）和烟曲霉（8.52 %）。烟曲霉和黄曲霉的共现相关性最强（lift = 4.72, p <； 0.001）。抗生素调整与改善治疗效果显著相关（OR = 5.33, p <； 0.001）。结论青少年肺炎支原体病原体负荷高于青壮年。血清LDH水平和发热与病原体负荷呈正相关。烟曲霉与黄曲霉之间存在协同检测模式。mNGS通过整合病原体负荷量化和共同检测谱，有效指导MPP诊断和抗生素治疗，为精准治疗提供关键证据。

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来源期刊

International Journal of Medical Microbiology 医学-病毒学

CiteScore

9.70

自引率

0.00%

发文量

审稿时长

45 days

期刊介绍： Pathogen genome sequencing projects have provided a wealth of data that need to be set in context to pathogenicity and the outcome of infections. In addition, the interplay between a pathogen and its host cell has become increasingly important to understand and interfere with diseases caused by microbial pathogens. IJMM meets these needs by focussing on genome and proteome analyses, studies dealing with the molecular mechanisms of pathogenicity and the evolution of pathogenic agents, the interactions between pathogens and host cells ("cellular microbiology"), and molecular epidemiology. To help the reader keeping up with the rapidly evolving new findings in the field of medical microbiology, IJMM publishes original articles, case studies and topical, state-of-the-art mini-reviews in a well balanced fashion. All articles are strictly peer-reviewed. Important topics are reinforced by 2 special issues per year dedicated to a particular theme. Finally, at irregular intervals, current opinions on recent or future developments in medical microbiology are presented in an editorial section.