{"id":25511,"date":"2024-05-24T04:07:00","date_gmt":"2024-05-23T20:07:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25511"},"modified":"2024-05-24T05:51:17","modified_gmt":"2024-05-23T21:51:17","slug":"blue-journal%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%92%88%e5%af%b9%e5%91%bc%e5%90%b8%e9%81%93%e6%84%9f%e6%9f%93%e7%9a%84icu%e6%82%a3%e8%80%85%e7%9a%84%e5%b8%b8%e8%a7%84%e5%ae%8f%e5%9f%ba","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25511","title":{"rendered":"[Blue Journal\u53d1\u8868\u8bba\u6587]\uff1a\u9488\u5bf9\u547c\u5438\u9053\u611f\u67d3\u7684ICU\u60a3\u8005\u7684\u5e38\u89c4\u5b8f\u57fa\u56e0\u7ec4\u5b66\u68c0\u67e5"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">Routine Metagenomics Service for ICU Patients with Respiratory Infection<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Themoula Charalampous,\u00a0\u00a0Adela Alcolea-Medina,\u00a0\u00a0Luke B. Snell, et al<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">Am J Respir Crit Care Med 2024; 209; 164-174<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">DOI: <a href=\"https:\/\/doi.org\/10.1164\/rccm.202305-0901OC\">https:\/\/doi.org\/10.1164\/rccm.202305-0901OC<\/a><strong>\u00a0<\/strong><\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Abstract<\/h4>\n\n\n\n<p><strong>Rationale:<\/strong>&nbsp;Respiratory metagenomics (RMg) needs evaluation in a pilot service setting to determine utility and inform implementation into routine clinical practice.<\/p>\n\n\n\n<p><strong>Objectives:<\/strong>&nbsp;Feasibility, performance, and clinical impacts on antimicrobial prescribing and infection control were recorded during a pilot RMg service.<\/p>\n\n\n\n<p><strong>Methods:<\/strong>&nbsp;RMg was performed on 128 samples from 87 patients with suspected lower respiratory tract infection (LRTI) on two general and one specialist respiratory ICUs at Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London.<\/p>\n\n\n\n<p><strong>Measurements and Main Results:<\/strong>\u00a0During the first 15\u2009weeks, RMg provided same-day results for 110 samples (86%), with a median turnaround time of 6.7\u2009hours (interquartile range\u2009=\u20096.1\u20137.5\u2009h). RMg was 93% sensitive and 81% specific for clinically relevant pathogens compared with routine testing. Forty-eight percent of RMg results informed antimicrobial prescribing changes (22% escalation; 26% deescalation) with escalation based on speciation in 20 out of 24 cases and detection of acquired-resistance genes in 4 out of 24 cases. Fastidious or unexpected organisms were reported in 21 samples, including anaerobes (<em>n<\/em>\u2009=\u200912),\u00a0<em>Mycobacterium tuberculosis<\/em>,\u00a0<em>Tropheryma whipplei<\/em>, cytomegalovirus, and\u00a0<em>Legionella pneumophila<\/em>ST1326, which was subsequently isolated from the bedside water outlet. Application to consecutive severe community-acquired LRTI cases identified\u00a0<em>Staphylococcus aureus<\/em>\u00a0(two with\u00a0<em>SCCmec<\/em>\u00a0and three with\u00a0<em>luk<\/em>\u00a0F\/S virulence determinants),\u00a0<em>Streptococcus pyogenes<\/em>\u00a0(<em>emm1-<\/em>M1uk clone),\u00a0<em>S. dysgalactiae<\/em>\u00a0subspecies equisimilis (STG62647A), and\u00a0<em>Aspergillus fumigatus<\/em>\u00a0with multiple treatments and public health impacts.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.atsjournals.org\/na101\/home\/literatum\/publisher\/thoracic\/journals\/content\/ajrccm\/2024\/ajrccm.2024.209.issue-2\/rccm.202305-0901oc\/20240103\/images\/large\/rccm.202305-0901ocf1.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.atsjournals.org\/na101\/home\/literatum\/publisher\/thoracic\/journals\/content\/ajrccm\/2024\/ajrccm.2024.209.issue-2\/rccm.202305-0901oc\/20240103\/images\/large\/rccm.202305-0901ocf2a.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.atsjournals.org\/na101\/home\/literatum\/publisher\/thoracic\/journals\/content\/ajrccm\/2024\/ajrccm.2024.209.issue-2\/rccm.202305-0901oc\/20240103\/images\/large\/rccm.202305-0901ocf2b.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<p><strong>Conclusions:<\/strong>&nbsp;This pilot study illustrates the potential of RMg testing to provide benefits for antimicrobial treatment, infection control, and public health when provided in a real-world critical care setting. Multicenter studies are now required to inform future translation into routine service.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Routine Metagenomics Service for ICU Patients with Resp [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25511"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25511"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25511\/revisions"}],"predecessor-version":[{"id":26065,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25511\/revisions\/26065"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25511"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25511"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25511"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}