Clinical Assessment of the Utility of Metagenomic Next-Generation Sequencing in Pediatric Patients of Hematology Department

Metagenomic Next-Generation Sequencing (mNGS) is an emerging technique for microbial identification and diagnosis of infectious diseases. The clinical utility of mNGS in the management of infections, especially its real-world impact on antimicrobial therapy and patient outcome has not been systematically evaluated. To that end, we prospectively assessed the effectiveness of mNGS in 70 febrile inpatients with suspected infections at the Hematology department of the Childrens Hospital, National Clinical Research Center for Child Health. 69/70 patients were given empirical antibiotics prior to mNGS. A total of 104 samples (62 plasma, 34 throat swabs, 4 bone marrow, 4 bronchoalveolar lavage) were collected on day 1-28 (mean 6.9) after symptom onset and underwent mNGS testing. Traditional microbial tests such as culture identified causal microorganisms in 5/70 (7.14%) patients that were in accordance with mNGS. In addition, mNGS reported possible pathogens when routine tests were negative. Antimicrobial treatment was adjusted in 55/70 (78.6%) patients that led to improvement/relief of symptoms within 3 days. On the other hand, in 15/70 (21.4%) patients, mNGS reports were considered irrelevant by a board of clinicians based on biochemical, serological, imaging evidence and experiences. We concluded that mNGS not only expanded the clinical capacity of pathogen detection, but also yielded positive impact on handling suspected infections through 1) differential diagnosis which may rule out infectious diseases and 2) modification and de-escalation of the empirical antibiotic regimen.