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Clinical and diagnostic values of metagenomic next-generation sequencing for infection in hematology patients: a systematic review and meta-analysis
Summary
This meta-analysis of 22 studies found that metagenomic next-generation sequencing (mNGS) had a substantially higher pathogen detection rate than conventional microbiological tests in hematology patients, with pooled sensitivity of 87%. The mNGS results led to antibiotic adjustments in about 50% of cases, demonstrating its clinical value for diagnosing infections in immunocompromised patients.
Abstract Objectives This meta-analysis will focus on systematically assessing the clinical value of mNGS for infection in hematology patients. Methods We searched for studies that assessed the clinical value of mNGS for infection in hematology patients published in Embase, PubMed, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI) from inception to August 30, 2023. We compared the detection positive rate of pathogen for mNGS and conventional microbiological tests (CMTs). The diagnostic metrics, antibiotic adjustment rate and treatment effectiveness rate were combined. Results Twenty-two studies with a total of 2325 patients were included. The positive rate of mNGS was higher than that of CMT (blood: 71.64% vs. 24.82%; BALF: 89.86% vs. 20.78%; mixed specimens: 82.02% vs. 28.12%). The pooled sensitivity and specificity were 87% (95% CI: 81–91%) and 59% (95% CI: 43–72%), respectively. The reference standard/neutropenia and research type/reference standard may be sources of heterogeneity in sensitivity and specificity, respectively. The pooled antibiotic adjustment rate according to mNGS was 49.6% (95% CI: 41.8–57.4%), and the pooled effective rate was 80.9% (95% CI: 62.4–99.3%). Conclusion mNGS has high positive detection rates in hematology patients. mNGS can guide clinical antibiotic adjustments and improve prognosis.
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