Metagenomic next-generation sequencing in patients with fever of unknown origin: A comprehensive systematic literature review and meta-analysis.

Autor: Marra AR; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Department of Internal Medicine, University of Iowa Carver College of Medicine, C51 GH - 200 Hawkins Drive, Iowa City, IA 52242, United States. Electronic address: alexandre-rodriguesmarra@uiowa.edu., Lopes GOV; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Pardo I; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Hsieh MK; Program of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States., Kobayashi T; Department of Internal Medicine, University of Iowa Carver College of Medicine, C51 GH - 200 Hawkins Drive, Iowa City, IA 52242, United States., Marra PS; University of California, San Francisco School of Medicine, San Francisco, CA, United States., Marschall J; Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States., Pinho JRR; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; LIM03/07, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil., Amgarten DE; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., de Mello Malta F; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Dos Santos NV; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Edmond MB; Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, United States.
Jazyk: angličtina
Zdroj: Diagnostic microbiology and infectious disease [Diagn Microbiol Infect Dis] 2024 Oct; Vol. 110 (2), pp. 116465. Date of Electronic Publication: 2024 Jul 23.
DOI: 10.1016/j.diagmicrobio.2024.116465
Abstrakt: Metagenomic Next-Generation Sequencing (mNGS) holds promise in diagnosing fever of unknown origin (FUO) by detecting diverse pathogens. We systematically reviewed the literature to evaluate mNGS's accuracy, clinical efficacy, and limitations in FUO diagnosis. Nine studies revealed mNGS's positivity rate ranging from 66.7% to 93.5% for bacterial bloodstream infections and systemic infections. Meta-analysis of three studies involving 857 patients, including 354 with FUO, showed a sensitivity of 0.91 (95% CI: 0.87-0.93) and specificity of 0.64 (95% CI: 0.58-0.70). Despite lower specificity, mNGS demonstrated a higher Diagnostic Odds Ratio (DOR) of 17.0 (95% CI: 4.5-63.4) compared to conventional microbiological tests (CMTs) at 4.7 (95% CI: 2.9-7.6). While mNGS offers high sensitivity but low specificity in identifying causative pathogens for FUO, its superior DOR suggests potential for more accurate diagnoses and targeted interventions. Further research is warranted to optimize its clinical application in FUO management.
Competing Interests: Declaration of competing interest Authors have no commercial or financial involvement with this manuscript.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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