Table 3.
Clinical management of 16 patients based on mNGS*.
| Culture | HSV-PCR | mNGS | Empirical antibiotics | Adjusted antibiotic | Outcome | |
|---|---|---|---|---|---|---|
| C54 | / | / | S.epidermidis | Ampicillin sulbactam/Ceftazidime | Vancomycin | Cured |
| C55 | / | / | CMV | Ampicillin sulbactam/Meropenem | / | AAD |
| C59 | / | / | E.coli | Meropenem | Meropenem | Cured |
| C62 | / | / | E.coli | Meropenem | Ampicillin sulbactam | Cured |
| C63 | / | HSV-2 | HSV-2 | Ampicillin sulbactam | Acyclovir | AAD |
| C65 | / | / | E.faecium | Vancomycin | Vancomycin | Cured |
| C69 | / | / | B.fragilis | Ampicillin sulbactam/Ceftazidime | Meropenem | Cured |
| C71 | / | / | E.faecalis | Ampicillin sulbactam/Meropenem | Ampicillin sulbactam/Meropenem | Cured |
| C73 | / | / | CMV | Ampicillin sulbactam | Ampicillin sulbactam/Ganciclovir | Cured |
| C74 | / | / | E.coli, CMV | Ampicillin sulbactam/Meropenem | Meropenem/Ganciclovir | Cured |
| C76 | / | / | S.agalactiae | Penicillin | Penicillin | Cured |
| C77 | E.coli | / | E.coli | Ampicillin sulbactam/Meropenem | Ampicillin sulbactam/Meropenem | AAD |
| C80 | / | / | M.hominis | Ampicillin sulbactam/ Ceftazidime/Vancomycin/Meropenem/Acyclovir |
Azithromycin | AAD |
| C84 | / | / | CMV | Ampicillin sulbactam/Ceftazidime | Ganciclovir | Cured |
| C85 | / | HSV-1 | HSV-1 | Meropenem | Acyclovir | AAD |
| C88 | / | / | E.coli | Meropenem | Meropenem | AAD |
*mNGS denotes metagenomic next-generation sequencing, HSV denotes herpes simplex virus, PCR denotes polymerase-chain-reaction, and AAD denotes against advice discharge.
Among these 16 patients, three were identified by both mNGS and conventional tests, and 13 (14.8%) were identified by mNGS alone. Twelve of 13 diagnoses based solely on mNGS had a likely clinical effect (one patient’s parents stopped treatment), with nine of 13 changing antibiotic treatments. Ampicillin sulbactam was used in high doses (ampicillin,200-300mg/kg·d, q6h).