Targeted next-generation sequencing of bronchoalveolar-lavage fluid specimens in the diagnosis of pulmonary infection after hematopoietic stem cell transplantation.
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OBJECTIVE: The purpose of this study was to compare the diagnostic performance of targeted next-generation sequencing (tNGS) with that of conventional microbiological tests (CMTs) in detecting pulmonary infections after hematopoietic stem cell transplantation (HSCT), to investigate pathogen distribution in pulmonary infections post-HSCT, and to provide laboratory-based evidence as a basis for the clinical diagnosis and treatment of such infections. METHODS: We retrospectively analyzed the clinical data of 132 patients with malignant hematological diseases complicated by pulmonary infections who were hospitalized at the Fourth Affiliated Hospital of Soochow University (Suzhou, China) from July 2023 to September 2024. RESULTS: Targeted NGS had a significantly higher overall detection rate (100 %) than CMTs (78 %; P < 0.001), particularly for bacteria (93.31 % vs. 49.02 %; P < 0.001) and viruses (91.32 % vs. 76.93 %; P < 0.01). Both methods exhibited similar performance for fungal detection (72.39 % vs. 69.51 %; P = 0.799). In HSCT patients, viral-bacterial coinfections predominated, with Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) being the most common pathogens. Targeted NGS had a shorter turnaround time (TAT) than CMTs, and antibiotic regimens were adjusted in 47.22 % of patients based on the tNGS results. CONCLUSION: The rapid identification of pulmonary-infection pathogens in patients post-HSCT using tNGS facilitated the precise adjustment of anti-infective regimens. Our findings can provide a foundation for developing empirical anti-infective treatment strategies tailored to pathogen distribution in this patient population.