宏基因组二代测序对脓毒症抗菌药物优化、临床预后及成本-效果的影响OA

Objective To evaluate the clinical decision-making value and health economics benefits of metagenomic next-generation sequencing(mNGS)using real-world data.Methods A total of 316 patients diagnosed with sepsis or severe infection at the First Affiliated Hospital of Anhui Medical University between January 1,and December 31,2023 were selected as study subjects.They were divided into mNGS group(n=177)and non-mNGS group(n=139)based on whether mNGS testing was performed.Generalized linear models(GLM)and multivariate Logistic regression were employed to adjust for confounding factors and analyze the impact of mNGS on treatment decisions,28-day mortality rate,and healthcare costs.Results Compared to non-mNGS group,intensive care unit(ICU)admission rates and sequential organ failure scores were higher in mNGS group(P<0.001).mNGS detection rate reached 81.9%,guiding antimicrobial optimization for 62.7%of positively matched patients,including treatment escalation in 86.5%of cases.After adjusting for disease severity,mNGS did not improve 28-day survival rates.GLM model analysis revealed that ICU admission and mechanical ventilation were primary cost drivers,resulting in an increased per capita medical expenditure of ¥7057 in mNGS group after adjustment.Conclusion Under the current late-stage rescue treatment paradigm,the mNGS strategy incurs higher costs without providing survival benefits.Early intervention to improve survival rates could potentially enhance its cost-effectiveness ratio.