Clinical performance of metagenomic next-generation sequencing for distinction and diagnosis of Mucorales infection and colonization

Xiaoli Zhou; Chenxi Yang; Xin Liu; Jiaqiang Wang; Yanqiao Li; Lingai Pan; Shengkun Peng; Hua Yu; Xiren Deng

doi:10.3389/fcimb.2025.1631960

Clinical performance of metagenomic next-generation sequencing for distinction and diagnosis of Mucorales infection and colonization

Front Cell Infect Microbiol. 2025 Sep 18:15:1631960. doi: 10.3389/fcimb.2025.1631960. eCollection 2025.

Authors

Xiaoli Zhou^#¹, Chenxi Yang^#¹, Xin Liu^#¹, Jiaqiang Wang¹, Yanqiao Li², Lingai Pan³, Shengkun Peng⁴, Hua Yu¹, Xiren Deng¹

Affiliations

¹ Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
² Department of Dermatology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
³ Department of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
⁴ Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

^# Contributed equally.

Abstract

Mucormycosis is a lethal fungal infection disease with high mortality rate. However, investigations assessing the value of metagenomic next-generation sequencing (mNGS) for distinguishing Mucorales infection from colonization are currently insufficient. A retrospective analysis of clinical date from 71 patients at Sichuan Provincial People's Hospital from September 2021 to September 2024 was conducted. The performance of mNGS in distinguishing Mucorales infection from colonization, along with the differences in patients' characteristics, imaging characteristics, antimicrobial adjustment, and microbiota, were examined. Among the 71 patients, 51 were identified as Mucorales infection group (3 proven and 48 probable cases), and 20 were colonization group (possible cases). Receiver operating characteristic (ROC) curve for mNGS indicated an area under the curve of 0.7662 (95%CI: 0.6564-0.8759), with an optimal threshold value of 51 for discriminating Mucorales infection from colonization. The infection group exhibited a higher proportion of antimicrobial adjustments compared to the colonization group (64.71% vs. 35.00%, P < 0.05), with antifungal agent changed being more dominant (43.14% vs. 10.00%, P < 0.01). Mucorales RPTM value, length of hospital stays, hsCRP, immunocompromised, malignant blood tumor, and antifungal changed were significantly positively correlated with Mucorales infection. Rhizomucor pusillus showed significant differences between the two groups. The abundance of Torque teno virus significantly increased in the infection group, whereas the colonization group exhibited higher abundance of Rhizomucor delemar. mNGS is a valuable tool for differentiating colonization from infection of Mucorales. Malignant blood tumor, immunocompromised, length of hospital stays and hsCRP were significant different indicators between patients with Mucorales infection from colonization.

Keywords: Mucorales; diagnosis; metagenomic next-generation sequencing; mucormycosis; optimal threshold value.

MeSH terms

Adult
Aged
Antifungal Agents / therapeutic use
Female
High-Throughput Nucleotide Sequencing* / methods
Humans
Male
Metagenomics* / methods
Microbiota
Middle Aged
Mucorales* / classification
Mucorales* / genetics
Mucorales* / isolation & purification
Mucormycosis* / diagnosis
Mucormycosis* / drug therapy
Mucormycosis* / microbiology
ROC Curve
Retrospective Studies

Substances

Antifungal Agents