Application of metagenomic next-generation sequencing technology in hematologic malignancy patients with sepsis following antibiotic use

Background Metagenomic next-generation sequencing (mNGS) has been widely applied in clinical pathogen detection; however, its utility in patients with hematologic malignancies complicated by sepsis after antibiotic therapy requires further investigation. Methods A total of 119 patients with hematologic malignancies complicated by sepsis, who had received antibiotic treatment for ≥ 3 days without clinical improvement, were enrolled in the study. All patients underwent simultaneous blood culture and mNGS analysis. The diagnostic value of mNGS and its impact on optimizing anti-infective therapy were evaluated. Results For the detection of bacterial and fungal pathogens, mNGS demonstrated a significantly higher positive rate compared to blood culture (89.36% vs. 25.53%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mNGS were 58.33%, 0.00%, 16.67%, and 0.00%, respectively. The overall agreement rate between the two methods was 13.21% (kappa = -0.202). Based on mNGS results, anti-infective treatment regimens were modified in 47 patients (39.49%). Granulocytopenia related to antitumor therapy was identified as a high-risk factor for polymicrobial infections ( P  < 0.05). Conclusions Patients with hematologic malignancies and sepsis, particularly those with antitumor therapy-induced granulocytopenia, are at increased risk for polymicrobial infections. Blood mNGS offers a rapid and comprehensive approach to pathogen identification, showing significant potential for guiding anti-infective therapy in this patient population.