Role of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing for diagnosis in focal pulmonary infectious diseases_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHI Baoyu ¹ , LI Yiheng ² , RUAN Ting ¹ , ZHANG Qin ¹ , XU Li ¹ ,  LI Ning ¹

1. Department of Pulmonary and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu 215002, P. R. China;
2. Class Two, Applied Statistics, Stony Brook Institute, Anhui University, Hefei, Anhui 230039, P. R. China;

Corresponding?author：

LI Ning, Email: chopperzoro@126.com

Keywords：

Non-real-time ultrasonic bronchoscope; Metagenomic Next-Generation Sequencing (mNGS); focal pulmonary infection; bronchial alveolar lavage fluid

DOI：

10.7507/1671-6205.202206047

Video：

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Objective To study the application of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing (mNGS) for diagnosis in focal pulmonary infectious diseases. Methods Prospective inclusion of patients with focal pulmonary infection were randomly divided into two groups, the experimental group used non-real-time ultrasound bronchoscopy positioning to collect bronchial alveolar lavage fluid (BALF), while the control group used chest CT position. BALF was subjected to mNGS and traditional microbial detection including traditional culture, the fungal GM test and Xpert (MTB/RIF). Result The positive rate of traditional culture (39.58% vs. 16.67%, P=0.013) and mNGS (89.58% vs. 72.92%, P=0.036) in experimental group was higher. The positive rate of Xpert MTB/RIF (4.17% vs. 2.08%, P=1) and fungal GM test (6.25% vs. 4.17%, P=0.765) was similar. The positive rate of bacteria and fungi detected by mNGS was higher than traditional culture (61.46% vs. 28.13%, P<0.001). Mycobacterium tuberculosis was similar to Xpert MTB/RIF (8.33% vs. 3.13%, P=0.21). Aspergillus was similar to GM test (7.29% vs. 5.21%, P=0.77). The total positive rate of traditional microbial methods was 36.46%, but 81.25% in mNGS (P<0.001). mNGS showed that 35 cases were positive and 13 kinds of pathogens were detected in control group, but 43 patients and 17 kinds of pathogens were detected in experimental group. The average hospitalization time [(12.92±3.54) days vs. (16.35±7.49) days] and the cost [CNY (12209.17±3956.17) vs. CNY (19044.10±17350.85)] of experimental group was less (P<0.001). Conclusions Non-real-time ultrasound bronchoscopy combined with mNGS can improve the diagnostic rate of focal pulmonary infectious diseases which is worthy of popularization and application in clinical practice.

Citation： SHI Baoyu, LI Yiheng, RUAN Ting, ZHANG Qin, XU Li, LI Ning. Role of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing for diagnosis in focal pulmonary infectious diseases. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(10): 725-730. doi: 10.7507/1671-6205.202206047 Copy

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4.	王繼靈, 楊莉, 陳國輝, 等. 新型經電子纖維支氣管鏡下防污染支氣管肺泡灌洗、支氣管肺泡灌洗以及常規痰檢法在肺部感染診治中的應用. 中華實驗和臨床感染病雜志(電子版), 2019, 13(3): 221-226.
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12.	溫劍鋒, 羅嘉韻, 廖衛平, 等. 經支氣管內鏡超聲引導與經支氣管鏡下介入治療支氣管結核的臨床對比. 中國現代藥物應用, 2020, 14(15): 59-61.
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14.	Abdelghani R, Thakore S, Kaphle U, et al. Radial endobronchial ultrasound-guided transbronchial cryobiopsy. J Bronchology Interv Pulmonol, 2019, 26(4): 245-249.
15.	Li G, Huang J, Li Y, et al. The value of combined radial endobronchial ultrasound-guided transbronchial lung biopsy and metagenomic next-generation sequencing for peripheral pulmonary infectious lesions. Can Respir J, 2020, 2020: 2367505.
16.	Pallen MJ. Diagnostic metagenomics: potential applications to bacterial, viral and parasitic infections. Parasitology, 2014, 141(14): 1856-1862.
17.	徐智察, 趙冬冬, 周華, 等. 宏基因組測序在感染性疾病病原學診斷中的應用. 中華臨床感染病雜志, 2019, 12(4): 302-308.
18.	Forbes JD, Knox NC, Ronholm J, et al. Metagenomics: the next culture-independent game changer. Front Microbiol, 2017, 8: 1069.
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20.	Forbes JD, Knox NC, Peterson CL, et al. Highlighting clinical metagenomics for enhanced diagnostic decision-making: a step towards wider implementation. Comput Struct Biotechnol J, 2018, 16: 108-120.
21.	Brown JR, Bharucha T, Breuer J. Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases. J Infect, 2018, 76(3): 225-240.
22.	Chao LS, Li JH, Zhang YN, et al. Application of next generation sequencing-based rapid detection platform for microbiological diagnosis and drug resistance prediction in acute lower respiratory infection. Ann Transl Med, 2020, 8(24): 1644.
23.	Wang W, Ren DY, Xu CH, et al. Pulmonary actinomycosis diagnosed by radial endobronchial ultrasound coupled with metagenomic next-generation sequencing: a case report and brief literature review. Int J Infect Dis, 2020, 100: 379-381.
24.	Chen JH, Li YQ, Li ZZ, et al. Metagenomic next-generation sequencing identified Histoplasma capsulatum in the lung and epiglottis of a Chinese patient: a case report. Int J Infect Dis, 2020, 101: 33-37.

1. 黎毅敏. 肺部感染病原學流行病學的變遷給我們的提示. 中華重癥醫學電子雜志(網絡版), 2016, 2(3): 167-170.
2. National Clinical Guideline Centre (UK). Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults. London: National Institute for Health and Care Excellence (UK), 2014, Dec. PMID: 25520986.
3. Str?lin K. Usefulness of aetiological tests for guiding antibiotic therapy in community-acquired pneumonia. Int J Antimicrob Agents, 2008, 31(1): 3-11.
4. 王繼靈, 楊莉, 陳國輝, 等. 新型經電子纖維支氣管鏡下防污染支氣管肺泡灌洗、支氣管肺泡灌洗以及常規痰檢法在肺部感染診治中的應用. 中華實驗和臨床感染病雜志(電子版), 2019, 13(3): 221-226.
5. Oki M, Saka H, Kitagawa C, et al. Endobronchial ultrasound-guided transbronchial biopsy using novel thin bronchoscope for diagnosis of peripheral pulmonary lesions. J Thorac Oncol, 2009, 4(10): 1274-1277.
6. Disayabutr S, Tscheikuna J, Nana A. The endobronchial ultrasound-guided transbronchial lung biopsy in peripheral pulmonary lesions. J Med Assoc Thai, 2010, 93 Suppl 1: S94-S101.
7. Eberhardt R, Anantham D, Ernst A, et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med, 2007, 176(1): 36-41.
8. Tsushima K, Sone S, Hanaoka T, et al. Comparison of bronchoscopic diagnosis for peripheral pulmonary nodule under fluoroscopic guidance with CT guidance. Respir Med, 2006, 100(4): 737-745.
9. Wilson MR, Sample HA, Zorn KC, et al. Clinical metagenomic sequencing for diagnosis of meningitis and encephalitis. N Engl J Med, 2019, 380(24): 2327-2340.
10. Gu W, Miller S, Chiu CY. Clinical metagenomic next-generation sequencing for pathogen detection. Annu Rev Pathol, 2019, 14: 319-338.
11. Jin XY, Yu JL, Yan J, et al. Diffuse miliary nodules in the bronchial mucosa observed by bronchoscopy: sarcoidosis or tuberculosis?. Clin Respir J, 2017, 11(1): 64-67.
12. 溫劍鋒, 羅嘉韻, 廖衛平, 等. 經支氣管內鏡超聲引導與經支氣管鏡下介入治療支氣管結核的臨床對比. 中國現代藥物應用, 2020, 14(15): 59-61.
13. Chen A, Chenna P, Loiselle A, et al. Radial probe endobronchial ultrasound for peripheral pulmonary lesions. A 5-year institutional experience. Ann Am Thorac Soc, 2014, 11(4): 578-582.
14. Abdelghani R, Thakore S, Kaphle U, et al. Radial endobronchial ultrasound-guided transbronchial cryobiopsy. J Bronchology Interv Pulmonol, 2019, 26(4): 245-249.
15. Li G, Huang J, Li Y, et al. The value of combined radial endobronchial ultrasound-guided transbronchial lung biopsy and metagenomic next-generation sequencing for peripheral pulmonary infectious lesions. Can Respir J, 2020, 2020: 2367505.
16. Pallen MJ. Diagnostic metagenomics: potential applications to bacterial, viral and parasitic infections. Parasitology, 2014, 141(14): 1856-1862.
17. 徐智察, 趙冬冬, 周華, 等. 宏基因組測序在感染性疾病病原學診斷中的應用. 中華臨床感染病雜志, 2019, 12(4): 302-308.
18. Forbes JD, Knox NC, Ronholm J, et al. Metagenomics: the next culture-independent game changer. Front Microbiol, 2017, 8: 1069.
19. 中華醫學會呼吸病學分會感染學組. 中國成人醫院獲得性肺炎與呼吸機相關性肺炎診斷和治療指南(2018年版). 中華結核和呼吸雜志, 2018, 41(4): 255-280.
20. Forbes JD, Knox NC, Peterson CL, et al. Highlighting clinical metagenomics for enhanced diagnostic decision-making: a step towards wider implementation. Comput Struct Biotechnol J, 2018, 16: 108-120.
21. Brown JR, Bharucha T, Breuer J. Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases. J Infect, 2018, 76(3): 225-240.
22. Chao LS, Li JH, Zhang YN, et al. Application of next generation sequencing-based rapid detection platform for microbiological diagnosis and drug resistance prediction in acute lower respiratory infection. Ann Transl Med, 2020, 8(24): 1644.
23. Wang W, Ren DY, Xu CH, et al. Pulmonary actinomycosis diagnosed by radial endobronchial ultrasound coupled with metagenomic next-generation sequencing: a case report and brief literature review. Int J Infect Dis, 2020, 100: 379-381.
24. Chen JH, Li YQ, Li ZZ, et al. Metagenomic next-generation sequencing identified Histoplasma capsulatum in the lung and epiglottis of a Chinese patient: a case report. Int J Infect Dis, 2020, 101: 33-37.

Chinese Journal of Respiratory and Critical Care Medicine

Role of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing for diagnosis in focal pulmonary infectious diseases

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