Clinical Features and Value of Tracheal Aspirate Metagenomic Next-Generation Sequencing for Severe Pneumonia in Children in Pediatric Intensive Care Unit

YU, XINYAN; LIANG, JIUCHAO; YANG, RUI; GAI, WEI; ZHENG, YAFENG

doi:10.33073/pjm-2025-016

Figures & Tables

Flow diagram of patient inclusion and exclusion.

The pathogen detected results of mNGS and CMT.
A) The types of infection identified in the children with severe pneumonia. The solid pie chart represents the proportion of single and mixed infections, and the other two hollow pie charts represent the specific pathogen types of single and mixed infections.
B) The coincidence between mNGS and CMT for pathogen identification. — The pathogen detected results of mNGS and CMT. A) The types of infection identified in the children with severe pneumonia. The solid pie chart represents the proportion of single and mixed infections, and the other two hollow pie charts represent the specific pathogen types of single and mixed infections. B) The coincidence between mNGS and CMT for pathogen identification.

The distribution of the identified pathogen spectrum.
A) The distribution of pathogens detected by mNGS and CMT.
B) The distribution of pathogens for children in the < 12 months group and the 12~144 months group. — The distribution of the identified pathogen spectrum. A) The distribution of pathogens detected by mNGS and CMT. B) The distribution of pathogens for children in the < 12 months group and the 12~144 months group.

Analysis of microbiome alpha and beta diversity between patients < 12 months and 12~144 months.
A) Alpha diversity differences of microbiota communities at the species level between groups. Each point represents one sample from each group. B) PCoA plot is based on Bray–Curtis’s distance between the children in groups. The x-axis is for grouping information, the y-axis is for distance information, the R-value is between (–1, 1) and there are significant differences between groups when the R-value is greater than zero and the P value is less than 0.05. — Analysis of microbiome alpha and beta diversity between patients < 12 months and 12~144 months. A) Alpha diversity differences of microbiota communities at the species level between groups. Each point represents one sample from each group. B) PCoA plot is based on Bray–Curtis’s distance between the children in groups. The x-axis is for grouping information, the y-axis is for distance information, the R-value is between (–1, 1) and there are significant differences between groups when the R-value is greater than zero and the P value is less than 0.05.

The top 20 microorganisms and their correlation with patient clinical data.
A) Top 20 most abundant species and their relative abundance. B) Differences between age groups for the top 20 most abundant microbes. * p-adjust < 0.05; ** p-adjust < 0.01; *** padjust < 0.001. Metastats analysis, p-value was adjusted using the Benjamini and Hochberg method. C) LEfSe analysis of respiratory microbiome between patients < 12 months and 12~144 months. Bar chart showing the log-transformed LDA scores of pathogen species identified by LEfSe analysis (the log-transformed LDA score of 4 as the threshold). — The top 20 microorganisms and their correlation with patient clinical data. A) Top 20 most abundant species and their relative abundance. B) Differences between age groups for the top 20 most abundant microbes. * p-adjust < 0.05; ** p-adjust < 0.01; *** padjust < 0.001. Metastats analysis, p-value was adjusted using the Benjamini and Hochberg method. C) LEfSe analysis of respiratory microbiome between patients < 12 months and 12~144 months. Bar chart showing the log-transformed LDA scores of pathogen species identified by LEfSe analysis (the log-transformed LDA score of 4 as the threshold).

Spearman correlations between the top 20 most abundant species and clinical data. * 0.01 < p < 0.05; ** 0.001 < p ≤ 0.01; *** p ≤ 0.001.

Demographic and clinical characteristics of patients_

Characteristics	Severe pneumonia (n = 55)	Children less than 12 months (n = 33)	Children aged 12~144 months (n = 22)	p-value^a
Age, month (M, IQR)	5.97 (3.28–30.50)	3.70 (2.80–4.63)	40.50 (24.75–51.75)	< 0.0001
< 12	33	/	/	/
12–144	22	/	/	/
Gender, male, n (%)	24 (43.64%)	18 (54.55%)	6 (27.27%)	0.0457
Symptoms, n (%)
Fever	24 (43.64%)	9 (27.27%)	15 (68.18%)	0.0027
Cough	41 (74.55%)	26 (78.79%)	15 (68.18%)	0.3764
Abnormal breathing	51 (92.73%)	33 (100%)	18 (72%)	0.0012
Unconsciousness	6 (10.91%)	3 (9.09%)	3 (13.64%)	0.5963
Apathetic	43 (78.18%)	23 (69.70%)	20 (90.91%)	0.0620
Fidgety	10 (18.18%)	2 (6.06%)	8 (36.36%)	0.0043
Laboratory examination (mean ± SD)
Pulse (times per minute)	106.9 ± 28.95	172.88 ± 22.49	143 ± 28.69	<0.0001
Respiratory rate (times per minute)	42.31 ± 11.39	44.55 ± 9.95	38.96 ± 12.77	0.0742
WBC	10.42 ± 4.79	11.03 ± 4.52	9.49 ± 5.14	0.2465
Hb	105.8 ± 18.72	104.82 ± 14.19	107.27 ± 24.30	0.6382
PLT	368.13 ± 183.67	441.64 ± 187.03	257.86 ± 110.54	0.0001
NEUT%	12.38 ± 23.53	9.60 ± 17.41	16.56 ± 30.53	0.2866
LY%	12.36 ± 23.38	17.66 ± 28.21	4.42 ± 9.15	0.0386
NEUT	5.02 ± 3.80	3.82 ± 2.49	6.80 ± 4.71	0.0035
HCT	31.38 ± 7.91	31.38 ± 6.79	31.38 ± 9.52	0.9990
CRP	21.06 ± 43.04	7.35 ± 19.80	41.63 ± 58.54	0.0029
PCT	2.61 ± 6.85	0.91 ± 2.84	5.09 ± 9.78	0.0260
BUN	4.93 ± 4.61	4.67 ± 2.95	5.33 ± 6.44	0.6157
Arterial blood pH	7.38 ± 0.08	7.37 ± 0.08	7.40 ± 0.08	0.2710
PaO₂	58.29 ± 17.37	57.67 ± 14.03	59.23 ± 21.77	0.7474
PaCO₂	43.78 ± 12.70	47.33 ± 11.44	38.45 ± 12.88	0.0097
HCO₃⁻	26.32 ± 8.26	26.93 ± 5.14	25.40 ± 11.55	0.5058
PaO₂/FiO₂	213.13 ± 64.00	221.33 ± 48.89	200.82 ± 81.41	0.2478
Premature, n	7 (12.73%)	6 (18.18%)	1 (4.55%)	0.1371
Post operation, n	3 (5.45%)	1 (3.03%)	2 (9.09%)	0.3322
Intubation, n	30 (54.55%)	19 (57.58%)	11 (50%)	0.5804
Mechanical ventilation, n	30 (54.55%)	19 (57.58%)	11 (50%)	0.5804
SOFA score	3.58 ± 2.03	3.48 ± 1.68	3.73 ± 2.51	0.6691
APACHE II score	13.45 ± 4.69	13.58 ± 3.95	13.27 ± 5.72	0.8167
LOHS (mean ± SD), day	16.49 ± 8.83	17.39 ± 9.72	15.14 ± 7.30	0.3579
ICU (mean ± SD), day	15.24 ± 8.87	16.76 ± 9.75	12.96 ± 6.97	0.1203
Outcomes, n
Cured	53 (96.36%)	32 (96.97%)	21 (95.45%)	0.7687
Died	2 (3.64%)	1 (3.03%)	1 (4.55%)	0.7687

Clinical Features and Value of Tracheal Aspirate Metagenomic Next-Generation Sequencing for Severe Pneumonia in Children in Pediatric Intensive Care Unit

Figures & Tables

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Demographic and clinical characteristics of patients_

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