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Scientific article
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English

Metagenomics for the microbiological diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia (HAP/VAP) in intensive care unit (ICU): a proof-of-concept study

Published inRespiratory research, vol. 24, no. 1, 285
Publication date2023-11-15
First online date2023-11-15
Abstract

Background: Hospital-acquired and ventilator-associated-pneumonia (HAP/VAP) are one of the most prevalent health-care associated infections in the intensive care unit (ICU). Culture-independent methods were therefore developed to provide faster route to diagnosis and treatment. Among these, metagenomic next-generation sequencing (mNGS) has shown considerable promise.

Methods: This proof-of-concept study describes the technical feasibility and evaluates the clinical validity of the mNGS for the detection and characterization of the etiologic agents causing hospital-acquired and ventilator-associated pneumonia. We performed a prospective study of all patients with HAP/VAP hospitalized in our intensive care unit for whom a bronchoalveolar lavage (BAL) was performed between July 2017 and November 2018. We compared BAL fluid culture and mNGS results of these patients.

Results: A total of 32 BAL fluids were fully analyzed. Of these, 22 (69%) were positive by culture and all pathogens identified were also reported by mNGS. Among the culture-positive BAL samples, additional bacterial species were revealed by mNGS for 12 patients, raising the issue of their pathogenic role (colonization versus coinfection). Among BALF with culture-negative test, 5 were positive in mNGS test.

Conclusions: This study revealed concordant results for pneumonia panel pathogens between mNGS and culture-positive tests and identified additional pathogens potentially implicated in pneumonia without etiologic diagnosis by culture. mNGS has emerged as a promising methodology for infectious disease diagnoses to support conventional methods. Prospective studies with real-time mNGS are warranted to examine the impact on antimicrobial decision-making and clinical outcome.

eng
Keywords
  • Hospital-acquired pneumonia
  • Metagenomics
  • Microbiological diagnosis
  • Next generation sequencing (NGS)
  • Ventilator-associated pneumonia
  • Humans
  • Pneumonia, Ventilator-Associated / microbiology
  • Prospective Studies
  • Bronchoalveolar Lavage Fluid / microbiology
  • Pneumonia / diagnosis
  • Pneumonia / microbiology
  • Intensive Care Units
  • Hospitals
  • Sensitivity and Specificity
Citation (ISO format)
HEITZ, Morgane et al. Metagenomics for the microbiological diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia (HAP/VAP) in intensive care unit (ICU): a proof-of-concept study. In: Respiratory research, 2023, vol. 24, n° 1, p. 285. doi: 10.1186/s12931-023-02597-x
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ISSN of the journal1465-9921
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Technical informations

Creation11/28/2023 1:12:49 PM
First validation03/05/2024 8:37:04 AM
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