Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study

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BACKGROUND: Pneumocystis jirovecii pneumonia (PJP), caused by Pneumocystis jirovecii (PJ), is an opportunistic infection prevalent in clinical settings. However, large-scale studies on the efficacy of metagenomic next-generation sequencing (mNGS)-based diagnosis of PJP in patients without human immunodeficiency virus infection (HIV) are lacking. METHODS: The study included 168 patients diagnosed with either PJP (84) or other pneumonia types (non-PJP patients; 84) who underwent mNGS-mediated bronchoalveolar lavage fluid (BALF) analysis, Gomori methenamine silver (GMS) staining and peripheral blood 1,3-beta-D-glucan (BDG) testing. Additionally, patients with PJP were categorized into survival (n = 55) and non-survival (n = 29) groups based on a 28-day in-hospital outcome to compare clinical characteristics, inflammatory markers, PJ sequence counts in BALF, and serum BDG levels. RESULTS: (13.7 % vs. 0, P= 0.005) relative to those in the survival group. CONCLUSION: The mNGS showed superior performance over serum BDG testing and GMS staining in diagnosing PJP in non-HIV patients and identified a broader range of coinfections.