Clinical Impact of Plasma Metagenomic Next-Generation Sequencing on Infection Diagnosis and Antimicrobial Therapy in Immunocompromised Patients.

Background: The clinical impact of plasma metagenomic next-generation sequencing (mNGS) on infection diagnosis and antimicrobial therapy in immunocompromised patients with suspected infection remains unclear.

Methods: Between March and December 2022, 424 cases with fever, infection history, mechanical ventilation, or imaging abnormalities underwent plasma mNGS testing at a single center. Eleven patients had received solid organ transplantation, and the remaining patients were categorized into febrile neutropenia (FN), non-neutropenia (NN), and non-transplant and non-hematologic disease (NTHD) groups based on immunosuppression severity. The diagnostic rate of infection and the utilization of antimicrobial agents based on mNGS were assessed.

Results: The use of mNGS significantly improved the diagnostic rates for fungi in the FN (65.1%, P = .001) and NN (58.8%, P = .008) groups versus the NTHD group (33.3%). Positive impacts associated with therapy were significantly greater than negative impacts across all 3 groups (all P < .001), and the utilization of escalation therapy was significantly more frequent in the FN group than in the NN group (P = .006). More than 70% of cases with negative mNGS results across the 3 groups underwent de-escalation therapy, with more than one-third being discontinued, preventing antimicrobial overuse.

Conclusions: Plasma mNGS has a clinically confirmed positive impact in immunocompromised patients with neutropenia, improving the diagnosis of fungal infections and antimicrobial therapy.