The Clinical Value of Metagenomic Next-Generation Sequencing in Pneumocystis jirovecii Pneumonia

Abstract

Background

The incidence of Pneumocystis jirovecii pneumonia (PJP) is increasing.

Methods

108 patients were analysed retrospectively at the Wuhan Union Hospital. The patients were classified into the PJP group or the P. jirovecii colonisation (PJC) group based on clinical diagnosis. Clinical data included demographics, laboratory examinations, treatment, and outcomes.

Results

A notable difference in the fungal load was seen between two groups, with median reads of 3215.79 vs. 5.61 in two groups, respectively (P<0.001). The optimal threshold value for discriminating P. jirovecii infection between colonisation for mNGS was six, and serum (1,3)-β-D-glucan (BDG) was 47.6 pg/mL. Besides, the positive detection rate of mNGS for co-pathogens in PJP patients was significantly higher than that of culture (88.16% vs. 22.37%, P<0.0001). Epstein-Barr virus and cytomegalovirus were the most common pathogens of co-infection in PJP patients. The antibiotic therapy in PJP patients was adjusted according to the mNGS results, of which seventeen (22.37%) were downgraded, 38 (50.0%) patients were upgraded, and 21 (27.63%) were unchanged. And almost all patients showed significant improvement in C-reactive protein.

Conclusion

mNGS is a promising and valuable technique with good performance for differentiating P. jirovecii infection and colonisation, the detection of pathogens, and antibiotic treatment.

Keywords:

• Pneumocystis jirovecii pneumonia
• Pneumocystis jirovecii
• clinical value
• metagenomic next-generation sequencing
• non-HIV

Ethical Approval Statement

The study was conducted according to the good clinical practice guidelines and the Declaration of Helsinki. This study was approved by the research ethics committee of Wuhan Union Hospital (2023-0177), and the need for obtaining written informed consent was waived due to the retrospective nature of this study and the fact that the data did not contain personal information about the patients. Patient data was used only for this study and was kept strictly confidential.

Acknowledgment

We express appreciation to the study participants for their valuable efforts, as well as to the Microbiology Laboratory of Wuhan Union Hospital for their generous support.

Author Contributions

Meng-Qi Huang and Ting-Ting Zheng contributed equally to this work and share first authorship. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.