Clinical Impact of Plasma Metagenomic Next-Generation Sequencing on Infection Diagnosis and Antimicrobial Therapy in Immunocompromised Patients

Abstract Background The clinical impact of plasma metagenomic next-generation sequencing (mNGS) on infection diagnosis and antimicrobial therapy in immunocompromised patients with suspected infection remains unclear. Methods Between March and December 2022, 424 cases with fever, infection history, mechanical ventilation, or imaging abnormalities underwent plasma mNGS testing at a single center. Eleven patients had received solid organ transplantation, and the remaining patients were categorized into febrile neutropenia (FN), non-neutropenia (NN), and non-transplant and non-hematologic disease (NTHD) groups based on immunosuppression severity. The diagnostic rate of infection and the utilization of antimicrobial agents based on mNGS were assessed. Results The use of mNGS significantly improved the diagnostic rates for fungi in the FN (65.1%, P = .001) and NN (58.8%, P = .008) groups versus the NTHD group (33.3%). Positive impacts associated with therapy were significantly greater than negative impacts across all 3 groups (all P < .001), and the utilization of escalation therapy was significantly more frequent in the FN group than in the NN group (P = .006). More than 70% of cases with negative mNGS results across the 3 groups underwent de-escalation therapy, with more than one-third being discontinued, preventing antimicrobial overuse. Conclusions Plasma mNGS has a clinically confirmed positive impact in immunocompromised patients with neutropenia, improving the diagnosis of fungal infections and antimicrobial therapy.