Metagenomic Next-Generation Sequencing in the Diagnosis of Infectious Fever During Myelosuppression Among Pediatric Patients with Hematological and Neoplastic Diseases

Abstract

Purpose

To analyze the contribution of metagenomic next-generation sequencing (mNGS) in the guidance of clinical treatment and outcomes of infection during myelosuppression among children with hematological and neoplastic diseases.

Patients and Methods

The clinical data and results of mNGS assay of febrile patients suspected of infection were retrospectively collected. The characteristics of pathogenic microorganisms and clinical course of myelosuppressed children with hematological diseases were summarized.

Results

Our study included 70 patients (45 males) with a median age of 5 years (range: 0.5 to 13 y). During the study period, there were 96 events of suspected infection. According to comprehensive clinical diagnosis, 73 blood infections, 43 pneumonia and 2 urinary tract infections occurred. The positive rate of mNGS was significantly higher than that of traditional microbial detection (83.3% vs 17.7%). The main pathogens detected by mNGS were Pseudomonas aeruginosa, Acinetobacter, human herpesvirus, Candida and Aspergillus. The average duration of fever was 4.9 days and 11.6 days (P < 0.05), and the average cost of anti-infection treatment was RMB ¥28,077 and 39,898 (P < 0.05) among children received mNGS within 48 hours and more than 48 hours after the onset of infection symptoms.

Conclusion

mNGS contributes to clinical management of children with infection during myelosuppression, especially among patients with negative traditional microbial detection. Early implementation of mNGS in children with symptoms has a tendency to reduce the time of infection, fever and the cost of treatment.

Keywords:

• metagene
• pathogenic microorganism
• child
• hematology and oncology

Ethics Approval and Consent to Participate

The study was approved by the ethics committee of the Children’s Hospital of Fudan University (IRB No. 2020-270) and was conducted in accordance with the Declaration of Helsinki. General informed consent was obtained according to the local ethical committee guidelines and obtained from the parents/legal guardian of the study participants prior to study commencement.

Acknowledgments

The authors thank our colleague Dr. Chengjun Sun for his comments to this article.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (82141125), the Cyrus Tang Foundation (ZSBK0070), Fudan University Education Development Foundation (ZSBK0046), Science and Technology Commission of Shanghai Municipality Project (19DZ1910602) and Shanghai Hospital Development Center Project (SHDC12019121).