The Impact of mNGS Technology in the Etiological Diagnosis of Severe Pneumonia in Children During the Epidemic of COVID-19

Abstract

Purpose

Metagenomic next-generation sequencing (mNGS) is an emerging technique for pathogen detection. However, most literature on the clinical application of pediatrics generally comprises case reports or small-scale cohort studies.

Patients and Methods

A total of 101 children with community-acquired severe pneumonia admitted to Tianjin Children’s Hospital from November 2021 to February 2022 were included. Pathogens in bronchoalveolar lavage fluid (BALF) specimens were detected using mNGS. The performances of mNGS and conventional tests on pulmonary infection diagnosis and pathogen identification were compared.

Results

According to our data, mNGS had a broader spectrum for pathogen detection. The mNGS results of BALF showed that the number of children with severe pneumonia hospitalized for mycoplasma pneumoniae infection was more than that for other bacterial infections during the COVID-19 epidemic. In addition, 43 cases (42.6%) had been identified with mixed infection, including 36 cases (35.6%) of Mycoplasma pneumoniae mixed with other pathogenic bacteria. Analytically, the mNGS exhibited significantly enhanced detection in the BALF as compared with the conventional laboratory pathogenic detection approaches (P < 0.05). The Pearson correlation analysis revealed positive correlation between the time of fever during hospitalization and the number of mycoplasma sequences (P < 0.05).

Conclusion

Compared with traditional methods, mNGS has a higher etiological detection rate and can comprehensively detect various pathogens of severe pneumonia. Therefore, mNGS of bronchoalveolar lavage fluid should be performed in children with severe pneumonia, which is of great significance for guiding treatment.

Keywords:

• mNGS
• severe pneumonia
• pathogen
• BALF
• children

Data Sharing Statement

The raw sequence data reported in this paper have been deposited in the Genome Sequence Archive (Genomics, Proteomics & Bioinformatics 2021) in National Genomics Data Center (Nucleic Acids Res 2022), China National Center for Bioinformation/Beijing Institute of Genomics, Chinese Academy of Sciences (GSA: CRA008160) that are publicly accessible at https://ngdc.cncb.ac.cn/gsa.

Ethics Approval and Informed Consent

This study was conducted complying with the Declaration of Helsinki. This study was reviewed and approved by the Ethics Committee of Tianjin Children’s Hospital. All the patients’ parents gave their Parental written consent for this study. All methods were carried out in relevant regulations and guidelines.

Acknowledgments

We thank all participants and staff of this study and the physicians at the Tianjin University Children’s Hospital. Changjiang Yu, Wei Guo, Zhulai Zhang and Yuting Ma are co-first authors for this study.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

This work was supported by Tianjin Science and Technology Bureau (21JCYBJC00460) and Tianjin Children’s Hospital (Y2020013).