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      《Chinese Journal of Critical Care Medicine》 2019-05
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      Clinical analysis of metagenomics next generation sequencing in the sepsis patients in Intensive Care Unit

      Tian Li-jun;Cao Zhi-long;Huang Xiao-ying;Han Xu-dong;Department of Intensive Care Unit,Nantong Third People's Hospital;  
      Objective To investigate the effects of metagenomics next generation sequencing(mNGS)on the treatment and prognosis of the patients with sepsis in Intensive Care Unit(ICU).Methods We performed a retrospective analysis of the patients with sepsis who had a mNGS report admitted to ICU according with the enrollment condition from September 2017 to December 2018.The records included the general clinical data,mNGS reports,and clinical microbiology reports before and after the mNGS.We evaluated the consistency of the mNGS with the clinical microbiology reports and clinical judgment.The healing change after the mNGS and the adjustment effect were also recorded.Results During the study period,a total of 20 patients with an average age of(58.15 ±17.30)years old submitted the mNGS.The acute physiology and chronic health evaluation II(APACHE II)score of these patients admitted to ICU was(23.00 ±9.48),and the sequential organ failure assessment(SOFA)score before submitting the mNGS was 5(4~11).The ICU mortality rate and the 28-day in-hospital mortality was 45% and 60%,respectively.A total of 22 samples were obtained from 20 patients,including 12 blood specimens,4 BALF specimens,3 sputum specimens,2 CSF specimens and1 ascites specimen.The proportion of viruses,gram-negative bacteria,gram-positive bacteria,fungus and tuberculous bacillus detected in the 20 patients was 11、9 、3、6 and 1,respectively.The positive rate of mNGS was significantly higher than traditional microbiological assay(19 vs.8,P0.01).Compared with clinical judgment,the coincidence rate with mNGS was also significantly higher than the traditional microbiological assay(18 vs.7,P0.01).According to the results of mNGS,the treatment was adjusted in 14 patients,and the clinical symptoms were improved in 9 patients.Conclusion The use of mNGS in the patients with sepsis in the ICU can improve the positive rate of pathogen detection and effectively guide treatment,which may improve the prognosis.
      【Fund】: 南通市科技计划项目(MS12017004-2 MS12018040);; 南通市卫健委科研课题(WKZL2018061)
      【CateGory Index】: R459.7
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