Objective:To study the clinical application of metagenomic next-generation sequencing (mNGS) on pathogen diagnosis and clinical management in neonatal sepsis.Methods:From January 2019 to February 2021, neonates suspected of sepsis receiving both mNGS and blood culture in our hospital were retrospectively reviewed. The effects of mNGS on pathogen detection, antibiotic choice and clinical management were analyzed.Results:A total of 35 neonates were included. Sepsis was confirmed in 24 neonates. 12 neonates had positive microbiology results (both mNGS and blood culture were positive in 3 cases, only mNGS positive in 8 cases and only blood culture positive in 1 case). mNGS showed higher positive rate than blood culture in patients with neonatal sepsis (45.8% vs. 16.7%, P=0.049). The concordance of mNGS and blood culture was 74.3%. 21 cases (60.0%) had antibiotics before testing and the positive rate showed no significant difference between mNGS and blood culture [19.0% (4/21) vs. 4.8% (1/21), P=0.343] in these patients. 14 cases didn't receive antibiotics before testing and the positive rate also showed no significant difference between mNGS and blood culture [28.6%(4/14) vs.21.4% (3/14), P=1.000]. 8.6% patients changed clinical treatment based on the mNGS results. Conclusions:mNGS increases pathogen detection in neonatal sepsis and is well consistent with blood culture. mNGS is useful in clinical practice.

Objective To investigate the clinical features and pathogenic types of suspected pertussis syndrome in infants,so as to provide reference for the treatment. Methods Seventy-one infants of suspected pertussis in Shanghai Children′s Medical Center from Nov 2016 to Aug 2017 were detected by the Filmarray which can detect Bordetella pertussis and 17 viruses. According to the results,the infants were divided into two groups:pertussis group(n=29) and pertussis-like group(n=42). According to the severity of the dis-ease,they were divided into mild group(n=50) and severe group(n=21). Clinical data was retrospectively analyzed and compared. Results All 71 infants came to the hospital with cough. Paroxysmal cough happened in 18 cases(62. 1％)in pertussis group,more common than that in pertussis-like group[9 cases(21. 4％)] (χ2 =12. 023,P<0. 01),and the WBC count,lymphocyte ratio,the mixed virus infection rate were higher in pertussis group than those in pertussis-like group[(20. 00 ± 8. 62) × 109/L vs. (13. 42 ± 6. 58) × 109/L,t=-3. 647,P<0. 01;(70. 38 ± 8. 97)％ vs. (56. 26 ± 20. 38)％,t = -3. 967,P <0. 01;22 cases(75. 9％) vs. 16 cases(38. 1％),χ2 =9. 836,P<0. 01]. The cases of mixed bacterial infection in pertussis-like group were 13(31. 0％),which was higher than that in pertussis group[3(10. 3％)](χ2 =4. 173,P<0. 05). The incidence of cyanosis was found in 12 cases(57. 1％)in severe group,which was more common than that of mild group[12 cases(24. 0％)](χ2 =7. 260,P<0. 01), and hospitalization days were(14. 5 ± 7. 8) days, which was higher than that in mild group[(7. 0 ± 3. 1)days] (t= -4. 250, P<0. 01). The infants in the pertussis group were given macrolides antibiotics and sulfamethoxazole complex,and the infants in the pertus-sis-like group were treated with antiviral and other specific treatment. Among 71 infants, 67 cases (94. 4％) were cured and 3 cases (4. 2％) were improved. Conclusion The clinical features of suspected pertussis in infants are not typical, so the early pathogenic diagnosis is very important. Filmarray detection system for multi PCR system can detect 20 kinds of pathogens with short operation time,which is very helpful for the early and rapid diagnosis of pathogens and rational use of drugs. It is worthy of clinical promotion.

Humans ; Nerve Tissue Proteins ; Epithelial-Mesenchymal Transition/genetics* ; Constriction, Pathologic ; Receptors, Immunologic ; Epithelial Cells/metabolism* ; Smad3 Protein/metabolism* ; Transforming Growth Factor beta1/metabolism*