Chest
Chest Infections: Original ResearchAdded Diagnostic Utility of Clinical Metagenomics for the Diagnosis of Pneumonia in Immunocompromised Adults
Section snippets
Study Design, Population, and Procedures
We performed a prospective observational cohort study of immunocompromised hosts with a clinical syndrome of pneumonia. This pilot study was designed as a noninterventional evaluation of the diagnostic value and hypothetical clinical impact of CMT + CM compared with CMT alone. Immunocompromised adult patients (≥18 years old) who underwent clinically indicated bronchoscopy and BAL for pneumonia were screened prospectively over a 2-year period (2017 to 2019) at Yale New Haven Hospital (New Haven,
Results
A total of 30 immunocompromised patients were enrolled (one patient had two separate admissions for pneumonia [episodes 13 and 19] for 31 observations in total; e-Table 2). Of 30 patients, 16 (53%) were men; 26 (87%) were White, and the median age was 66 years (range, 29 to 89 years). Figure 2 gives underlying immunosuppressive conditions and agents, chest imaging findings, and antimicrobial regimens before bronchoscopy. In all but three subjects, antimicrobials were administered before
Discussion
In this study, we evaluated the diagnostic utility of a commercial BAL metagenomics test in combination with CMT for pneumonia in immunocompromised adult patients who underwent bronchoscopy/BAL. Compared with CMT alone, the addition of BAL CM increased the diagnostic yield of potential pathogens for pneumonia (35% vs 58%). In particular, the addition of CM to CMT lead to improved detection of bacterial organisms including aggressive pathogens that potentially accounted for the patient’s
Acknowledgments
Author contributions: M. A. and C. D. C. conceptualized the study; M. A. wrote the manuscript; R. S., M. M., S. B., T. S S., H. X., C. D. C. reviewed and edited the manuscript; R. S., T. S., and H. X. performed clinical metagenomics testing.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: R. S. reports personal fees from IDbyDNA Inc during the conduct of the study; grants and personal fees from Roche Molecular Diagnostics, personal fees from Hologic, outside
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FUNDING/SUPPORT: This work was supported by the institutional funds supporting the Center for Pulmonary Infection Research and Treatment at Yale which covered the recruitment collection and operational costs of the study and by IDbyDNA, which provided Explify CM testing and results.