Translational pediatrics · 2026
Targeted next-generation sequencing reveals pathogen spectrum, drug resistance characteristics, and clinical determinants in children with community-acquired pneumonia.
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Cai Pei-Pei, Shen Dong, Yan Ru-Hong, Wen Jiang-Tao, Zhang Chang-Song, Chen Bei
Аннотация
BACKGROUND: This study aimed to apply targeted next-generation sequencing (tNGS) to analyze the pathogen distribution in children with acute respiratory tract infections (ARTIs) in our region, compare the diagnostic performance of tNGS with that of the rapid Mycoplasma pneumoniae (MP) immunoglobulin M (IgM) antibody test, and investigate the clinical characteristics of MP infection, the impact of macrolide resistance genes on disease severity, factors associated with the need for bronchoalveolar lavage (BAL), and the clinical relevance of tetracycline use. Our findings are intended to provide a scientific basis for precise diagnosis and rational antimicrobial therapy in pediatric respiratory infections.
METHODS: Blood parameters, including white blood cell (WBC) count, neutrophil percentage (Neut%), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and MP-IgM, were collected from pediatric patients aged 3 months to 13 years [median 7 years (interquartile range, IQR: 4-8 years)]. A retrospective analysis was performed by integrating these laboratory findings with oropharyngeal swab tNGS results, clinical data, and medication records.
RESULTS: Viruses were the most frequently detected pathogens in children with ARTIs, accounting for 70.57% of cases. WBC count showed statistically significant differences in assessing infection types among children aged >6 years. Among MP-IgM (colloidal gold assay)-positive cases, 53.90% tested negative for MP by tNGS. The overall MP detection rate was 32.20%, with a macrolide resistance gene detection rate of 86.3%; all resistance mutations occurred at the A2063G site of the 23S rRNA gene. The MP-positive group more frequently presented with lobar pneumonia (54.21% vs. 7.59%), longer fever duration (5.25 vs. 4.00 days), and older age (7 vs. 5 years). The MP-negative group had higher rates of bilateral lung involvement (70.89% vs. 42.06%), viral detection (86.10% vs. 46.73%), and wheezing (11.39% vs. 2.80%). Tetracycline therapy did not significantly improve clinical outcomes in MP-infected children. Neut%, lobar pneumonia, use of cephalosporins, and intravenous immunoglobulin (IVIG) were independent predictors for BAL requirement. The presence of resistance genes was not associated with more severe outcomes, whereas MP positivity and lobar pneumonia were identified as risk factors for disease progression.
CONCLUSIONS: Age, fever duration, and lobar pneumonia may assist in the assessment of MP infection. MP-IgM (colloidal gold assay) results should be interpreted in conjunction with other clinical indicators. The use of tetracyclines for MP infection requires careful benefit-risk evaluation. Cephalosporin use was associated with a lower likelihood of BAL requirement, whereas a higher Neut% and the presence of lobar pneumonia were associated with a higher likelihood of BAL requirement.
METHODS: Blood parameters, including white blood cell (WBC) count, neutrophil percentage (Neut%), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and MP-IgM, were collected from pediatric patients aged 3 months to 13 years [median 7 years (interquartile range, IQR: 4-8 years)]. A retrospective analysis was performed by integrating these laboratory findings with oropharyngeal swab tNGS results, clinical data, and medication records.
RESULTS: Viruses were the most frequently detected pathogens in children with ARTIs, accounting for 70.57% of cases. WBC count showed statistically significant differences in assessing infection types among children aged >6 years. Among MP-IgM (colloidal gold assay)-positive cases, 53.90% tested negative for MP by tNGS. The overall MP detection rate was 32.20%, with a macrolide resistance gene detection rate of 86.3%; all resistance mutations occurred at the A2063G site of the 23S rRNA gene. The MP-positive group more frequently presented with lobar pneumonia (54.21% vs. 7.59%), longer fever duration (5.25 vs. 4.00 days), and older age (7 vs. 5 years). The MP-negative group had higher rates of bilateral lung involvement (70.89% vs. 42.06%), viral detection (86.10% vs. 46.73%), and wheezing (11.39% vs. 2.80%). Tetracycline therapy did not significantly improve clinical outcomes in MP-infected children. Neut%, lobar pneumonia, use of cephalosporins, and intravenous immunoglobulin (IVIG) were independent predictors for BAL requirement. The presence of resistance genes was not associated with more severe outcomes, whereas MP positivity and lobar pneumonia were identified as risk factors for disease progression.
CONCLUSIONS: Age, fever duration, and lobar pneumonia may assist in the assessment of MP infection. MP-IgM (colloidal gold assay) results should be interpreted in conjunction with other clinical indicators. The use of tetracyclines for MP infection requires careful benefit-risk evaluation. Cephalosporin use was associated with a lower likelihood of BAL requirement, whereas a higher Neut% and the presence of lobar pneumonia were associated with a higher likelihood of BAL requirement.