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目的:探讨宏基因二代测序（mNGS）技术在经验性治疗失败肺部感染患者中的应用。方法:回顾性对上海交通大学医学院附属第九人民医院2021年9月至2023年11月收治的64例经验性治疗失败肺部感染患者进行分析，采集患者痰液、支气管肺泡灌洗液等进行传统病原学检测及肺泡灌洗液mNGS检测，比较传统病原学检测方法与mNGS检测方法对经验性治疗失败肺部感染患者病原体检测的差异。结果:64例经验性治疗失败肺部感染患者中，肺泡灌洗液mNGS微生物检测阳性率高于传统病原学检测[87.50% （56/64）比57.81%（37/64）]，差异有统计学意义（ P<0.01）。在mNGS检出的微生物中最常见为细菌感染，以铜绿假单胞菌、肺炎克雷伯菌、副流感嗜血杆菌为主。mNGS在混合感染的检出率高于传统病原学检测[（65.63% （42/64）比15.63%（10/64）]，差异有统计学意义（ χ2 = 33.17， P<0.01）。18例患者经mNGS技术检出耐药基因，共检出21种耐药基因。有53.13%（34/64）的患者根据mNGS检测结果进行抗生素调整后病情好转。 结论:mNGS技术可有效提高经验性治疗失败肺部感染患者微生物阳性检出率，且可辅助评估抗菌药物耐药性基因，指导临床抗菌药物调整，从而提升治疗效果。

Objective:To explore the application of metagenomic next-generation sequencing (mNGS) in patients with pulmonary infection after failure of empirical treatment.Methods:From September 2021 to November 2023, a total of 64 patients with pulmonary infection who failed to receive empirical treatment in the Ninth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively analyzed, sputum and bronchoalveolar lavage fluid of patients were collected for traditional etiological detection and mNGS detection in alveolar lavage fluid, and the differences between traditional etiological detection methods and mNGS detection methods for pathogen detection in patients with pulmonary infection after failure of empirical treatment were compared.Results:In 64 patients with pulmonary infection after failure of empirical treatment, the positive rate of mNGS microbial detection in alveolar lavage fluid was higher than that of traditional etiological detection: 87.50%(56/64) vs. 57.81%(37/64), and the difference was statistically significant ( P<0.01). The most common microorganisms detected by mNGS were bacterial infections, the main bacteria were Pseudomonas aeruginosa, Klebsiella pneumoniae and Haemophilus paraininfluenzae. The detection rate of mNGS in mixed infection was higher than that of traditional etiological detection: 65.63%(42/64) vs. 15.63%(10/64), χ2 = 33.17, P<0.01. Drug resistance genes were detected by mNGS technique in 18 patients, and a total of 21 kinds of drug resistance genes were detected, 53.13%(34/64) of patients improved after antibiotic adjustment based on mNGS test results. Conclusions:mNGS technology can effectively improve the positive microbial detection rate of patients with pulmonary infection after failure of empirical treatment, and can assist in the evaluation of antimicrobial resistance genes and guide the adjustment of clinical antibiotics, so as to improve the therapeutic effect.