Etiology of initial treatment failure in non-immunosuppressed adult patients with community-acquired pneumonia

作者：Yuanyuan Li, Chao Sun, Tingting Zhao, Yueyan Ni, Qing Liu, Mengyue Song, Xiaoyong Xu, Wenkui Sun, Yuanqin Li, Jun Zhou, Dan Li, Qi Zhang, Chunlai Feng, Jiaxin Shi, Min Cao, Baoju Huang, Nan Su, Xin Lu, Li Wang, Lei Jing, Linli Sang, Wei Zhou, Xiaomin Cai, Jiamei Wang, Yujie Wang, Y. Cai, Yajie Lu, Jinjin Zhong, Xin Su · 发表于：International Journal of Infectious Diseases · 年份：2025 · DOI：10.1016/j.ijid.2025.108110 · 被引用次数：3 · 研究领域：Pneumonia and Respiratory Infections、Pneumocystis jirovecii pneumonia detection and treatment、Respiratory viral infections research

OBJECTIVES: Initial treatment failure (ITF) of community-acquired pneumonia (CAP) is a significant clinical problem. The study aimed to explore the etiology of ITF using metagenomic next-generation sequencing (mNGS) and targeted next-generation sequencing (tNGS), and to provide optimized management strategies for patients with CAP. METHODS: From June 2022 to August 2024, we conducted a prospective, multicenter study in 15 hospitals of non-immunosuppressed adult CAP patients with ITF in Jiangsu Province, China. Conventional microbiological tests (CMTs), mNGS, and tNGS were applied to detect microorganisms in bronchoalveolar lavage fluid. RESULTS: ITF was mainly caused by responsible pathogens not covered by initial treatment (59.0%) despite the high compliance with guideline-recommended regimens. The top 5 responsible pathogens were Chlamydia psittaci (21.5%), Mycoplasma pneumoniae (16.7%), influenza virus (14.6%), SARS-CoV-2 (8.3%), and Pseudomonas aeruginosa (6.3%). The positive pathogen identification rate for mNGS and tNGS was 74.4% and 72.7%, respectively, while for CMTs it was 12.2%. Based on NGS results, treatment was optimized in 53.5% of patients, and 95.8% were improved or cured. CONCLUSIONS: Atypical pathogens and viruses not covered by empirical treatment regimens were the main causes of ITF. mNGS and tNGS outperformed CMTs in identifying responsible pathogens and could optimize the treatment of patients with ITF.