Clinical utility of the targeted next-generation sequencing for detection of Mycoplasma pneumoniae and antimicrobial resistance genes for adults

Background: Mycoplasma pneumoniae pneumonia (MPP) is common in children, and its incidence among adolescents and adults has been increasing in recent years. Targeted next-generation sequencing (tNGS) is a rapid, accurate and comprehensive method for pathogen detection; however, few studies have investigated its application value in the diagnosis of MPP. Methods: Ninety patients (aged over 14 years) were enrolled in this study and divided into MPP group (31 cases) and non-Mycoplasma pneumoniae pneumonia (non-MPP) group (59 cases). Clinical data, thin-slice spiral computed tomography (CT) scans of the lungs, tNGS results from bronchoalveolar lavage fluid (BALF) and blood samples, as well as other routine biochemical and traditional respiratory pathogen detection results, were collected. Clinical manifestations, etiological findings, and the performance of tNGS detection were compared between adolescent and adult patients with MPP and non-MPP for clinical reference. Results: Compared with the non-MPP group, adolescent and adult MPP patients exhibited distinct clinical features, including yellow sputum (35.5% vs. 88.1%, P = 0.03), headache (12.9% vs. 5.1%, P = 0.027), bronchial wall thickening (61.3% vs. 5.1%, P < 0.001), alveolar nodular exudative changes (51.6% vs. 3.9%, P < 0.001), and large airway sputum plugs (3.2% vs. 23.7%, P = 0.029). The sensitivity of tNGS in detecting Mycoplasma pneumoniae (M. pneumoniae) was 96.8%, which was superior to that of qPCR (80.6%) and IgM antibodies (67.7%). This technology can also simultaneously detect the coexistence of multiple pathogens with M. pneumoniae. Additionally, tNGS detected 10 antimicrobial resistance genes (ARGs) and 15 virulence factor genes in this study. Conclusions: The imaging manifestations of MPP in adolescents and adults exhibit certain characteristics. Early recognition and timely diagnosis are the key to accurate diagnosis and improve prognosis. TNGS has superior diagnostic accuracy and provides essential data on resistance, its potential as a supplementary tool to assist in the quick detection of M. pneumoniae in adults remains promising. Clinical trial number: Not applicable.