Clinical Application Of Metagenomic Next-Generation Sequencing In Non-Immunocompromised Patients With Severe Pneumonia Supported By Veno-Venous Extracorporeal Membrane Oxygenation
Objectives: This study aims to investigate the pathogen-detected effect and clinical therapy value of mNGS technologies in non-immunocompromised patients with severe pneumonia supported by vv-ECMO. Methods: The study retrospectively enrolled 50 non-immunocompromised patients with severe pneumonia supported by vv-ECMO from January 2016 to December 2022. Patients were categorized into two groups based on their discharge status: deterioration group (Group D) (n = 31) and improvement group (Group I) (n = 19). Baseline characteristics and clinical data were collected, including information on pathogens and antibiotic regimens. Results: Out of 50 ECMO patients enrolled, the group D had more male gender (80.6% vs. 52.6%, p < 0.05) , more smoking (54.8% vs. 21.1%, p < 0.05) and was older than group I (55.16±16.34 years vs. 42.32±19.65 years, p < 0.05). 64 samples underwent mNGS detection with 55 (85.9%) testing positive, 83.7%(36/43) in group D, 90.5%(19/21) in group I. Additionally, the positive rate of traditional culture was 64.9% (74/114). Out of 54 samples tested with both culture and mNGS, 23 (42.6%) had consistent pathogen identification, 13 (24.1%) were partially consistent, and 18 (33.3%) were completely inconsistent. Among the inconsistent ones, 14 (77.8%) were negative for culture while two each (11.1%) were negative for mNGS or mismatched. However, mNGS detected more pathogens and strains than traditional culture (65 strains vs. 23 strains), including 56 in group D, 26 in group I and 17 overlapping strains. The most frequently detected pathogens by mNGS were Klebsiella Pneumoniae, Cytomegalovirus, and Acinetobacter baumannii. A variety of G+ bacteria, fungi, viruses, and specific pathogens were detected only in group D, while Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae were higher in group D than in group I. mNGS led to the antibiotic treatment adjustment in 26 patients (52.0%) . Conclusions: mNGS has a distinct advantage in detecting mixed pathogens and guiding personalized antibiotic treatment for non-immunocompromised patients with severe pneumonia supported by vv-ECMO, which may help alleviate the issues of excessive antibiotic use, antimicrobial resistance, and misuse of medical resources.