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

Figures & data

Figure 1 Flow diagram of participants through study.

Table 1 Test Data of the 96 Suspected Infections

Variable	Number of Suspected Infections (n)	Ratio (%) n = 96
mNGS
Positive	80	83.3
Negative	16	16.7
Traditional microbial detection
Positive blood culture	9	9.4
Positive fecal culture	4	4.2
Positive urine culture	2	2.1
Positive serological test	2	2.1
Negative	79	82.2
Neutropenia
Agranulocytosis	52	54.2
Normal	44	45.8
Chest CT
Abnormal	43	44.8
Normal	53	55.2
Clinical diagnosis
Bloodstream infection	73	76.0
Pneumonia	43	44.8
Urinary infection	2	2.1

Abbreviation: mNGS, Metagenomic next-generation sequencing.

Table 2 Relationship Between mNGS Detection and Clinical Diagnosis

		Clinical Diagnosis
		Positive (n)	Negative (n)
mNGS	Positive (n)	78	2
	Negative (n)	7	9
Traditional microbial detection	Positive (n)	15	2
	Negative (n)	70	9

Figure 2 Microbial detection results of the 96 suspected infections.

Notes: ^aTMD = mNGS, TMD detected the same pathogens as reported by mNGS. ^bTMD ≠ mNGS, TMD detected the different pathogens as reported by mNGS; ^cTMD (Escherichia coli, blood culture), mNGS (Pseudomonas aeruginosa, Acinetobacter haemolyticus, Acinetobacter baumannii). After comprehensive consideration, the TMD report was clinically relevant; ^dTMD (Staphylococcus epidermidis, blood culture), mNGS (Klebsiella pneumoniae). The patients of the two suspected infections were different, but the test results are the same. After comprehensive consideration, the mNGS report was clinically relevant. The TMD reports were considered to be specimen contamination during percutaneous puncture; ^e(1) TMD (Escherichia coli, fecal culture), mNGS (Mycobacterium abscessus); (2) TMD (Escherichia coli, fecal culture), mNGS negative. Results of two independent suspected infection courses in a single patient. The final diagnosis was drug-induced fever. When the patient had no suspected infection symptoms in the past, the fecal culture also reported Escherichia coli. The TMD reports were considered as microbial colonization; ^f(1) TMD (Achromobacter xylosoxidans, blood culture), mNGS negative; (2) TMD (Enterobacter cloacae, Serratia marcescens, blood culture), mNGS negative. The TMD report was clinically relevant.

Abbreviations: TMD, traditional microbial detection; mNGS, metagenomic next-generation sequencing; TP, true positive; FP, false positive; TN, true negative; FN, false negative.

Figure 3 Results of pathogenic microorganisms in mNGS.

Table 3 Relationship Between Sampling Time of mNGS and Fever Time and Treatment Cost

	Sampling Time of mNGS		P value
	< 48 h	≥ 48 h
Average duration of fever (h)	4.9	11.6	0.0001
Average anti infection treatment (RMB ¥)	28,077	39,898	0.0194
Average total hospitalization cost (RMB ¥)	97,236	128,475	0.0384