Application of mNGS to describe the clinical and microbial characteristics of severe burn a tanker explosion at a tertiary medical center: a retrospective study patients following

Abstract

Background Multiple organ dysfunction syndrome secondary to infection is the leading cause of death in burn patients. Bloodstream infection (BSI) and the prognosis of burn patients are negatively correlated. Metagenomic next-generation sequencing (mNGS) can detect many potential pathogens and may be more valuable for patients with severe burns. Methods We retrospectively explored the utility of mNGS in describing the clinical and microbial characteristics of severely burned patients with BSI. We compared mNGS with blood culture. Results Fourteen patients (127 blood samples) developed 71 episodes of BSIs with 102 unique causative pathogens. The median total body surface area was 93%. The overall 90-day mortality was 43%. In total, 17 (23.9%) episodes were polymicrobial, and 61 (86.1%) episodes originated from the wound. In total, 62/71 cases (87%) showed positive findings by mNGS, while 42/71 cases (59%) showed positive findings using blood culture. We found that mNGS outperformed culture, especially in terms of fungi (27% vs. 6%, p < 0.0001). Conclusions The incidence of BSI and polymicrobial in patients with large-area severe burns is high. mNGS has potential value in the diagnosis of fungal infections and coinfections in such patients. In addition, mNGS may provide unique guidance for antibiotic therapy in complicated BSI.

Pathogen load and species monitored by droplet digital PCR in patients with bloodstream infections: A prospective case series study

“…In a prospective randomized controlled trial of 617 blood culture-positive patients, Banerjee et al [ 32 ] observed that multiplex PCR assay combined with the real-time antimicrobial stewardship could shorten the time from Gram staining to appropriate antimicrobial escalation or de-escalation. In 14 patients with severe burns, mNGS testing has also been shown to have potential value in the diagnosis of polymicrobial BSIs and can provide accurate guidance for antibiotic therapy [ 33 ]. In this study, we observed that the changes in pathogens load and number of species determined by ddPCR have potential value for guiding the use of antibiotics in critically ill patients with BSIs.…”

Molecular Methodologies for Improved Polymicrobial Sepsis Diagnosis

“…Its performance for the detection of bloodstream infections is adequate, with one study reporting sensitivity and specificity of 87.1% and 80.2%, respectively [100]. It has also been shown to outperform blood culture for the detection of fungi and difficultto-culture bacteria, with Wu et al reporting an 87% pathogen detection rate compared to 59% for blood culture [101]. The usefulness of mNGS, particularly in detecting polymicrobial infections, has also been demonstrated in other related infectious diseases, such as pneumonia [102,103].…”