BALF-mNGS-Derived Microbial Detection Profiles and Their Associations with Clinical Severity in Immunocompromised Patients with Community-Acquired Pneumonia.
6 affiliations
- 1Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.
- 2Department of Critical Care Medicine, Quzhou TCM Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University, Quzhou, Zhejiang, People's Republic of China.
- 3Department of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China.
- 4Department of Critical Care Medicine, Longyou County People's Hospital, Quzhou, Zhejiang, People's Republic of China.
- 5Department of Pulmonary and Critical Care Medicine, Quzhou Second People's Hospital, Quzhou, Zhejiang, People's Republic of China.
- 6Department of Pulmonary and Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, People's Republic of China.
Abstract
Background
Immunocompromised patients with community-acquired pneumonia (CAP) have heterogeneous pulmonary microbial profiles and frequently experience a severe clinical course. Whether bronchoalveolar lavage fluid metagenomic next-generation sequencing (BALF-mNGS)-derived microbial features are associated with clinical severity in this population remains unclear.Objective
To characterize pulmonary microbial features in immunocompromised patients with CAP and evaluate their association with ICU admission and length of hospital stay (LOHS).Methods
This multicenter retrospective study included 1072 patients with CAP who underwent BALF-mNGS at five hospitals (August 2021-June 2025), including 362 immunocompromised and 710 immunocompetent patients. Microbial diversity, composition, and differentially enriched taxa were compared by immune status. Among immunocompromised patients, taxon-outcome associations were assessed using adjusted logistic and negative binomial regression, with sensitivity analyses additionally adjusting for antibiotic and antifungal exposure before BALF.Results
Immunocompromised patients had higher alpha diversity (P<0.001), with limited overall community separation. Five taxa were enriched: Burkholderia multivorans, Klebsiella pneumoniae, Candida glabrata, Candida tropicalis, and Streptococcus pseudopneumoniae. In primary analyses, B. multivorans abundance was associated with ICU admission (adjusted odds ratio [aOR] 1.400, 95% CI 1.088-1.801; false discovery rate [FDR]-adjusted P=0.045) and longer LOHS (adjusted incidence rate ratio [aIRR] 1.108, 95% CI 1.036-1.186; FDR-adjusted P=0.014). C. glabrata was associated with longer LOHS (aIRR 1.101, 95% CI 1.023-1.185; FDR-adjusted P=0.026). K. pneumoniae showed a nominal ICU association that did not survive FDR correction (FDR-adjusted P=0.084). After additional adjustment for antibiotic and antifungal exposure, the associations of B. multivorans and C. glabrata with longer LOHS remained significant (both FDR-adjusted P=0.044), whereas the association between B. multivorans and ICU admission did not (FDR-adjusted P=0.168).Conclusion
BALF-mNGS-derived microbial features showed limited overall community differences but distinct taxon-specific associations with clinical severity. These exploratory findings require further validation before their prognostic or clinical utility can be established.
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BibTeX
@article{luo2026balfmngsderived,
title = {{BALF-mNGS-Derived Microbial Detection Profiles and Their Associations with Clinical Severity in Immunocompromised Patients with Community-Acquired Pneumonia.}},
author = {Liying Luo and Junjie Zhao and Jiancheng Zhuge and Honglong Fang and Lingmin Yuan and Jianfei Wang and Zhidan Hua and Yidan Cui},
journal = {Infection and drug resistance},
year = {2026},
month = oct,
doi = {10.2147/idr.s657668},
url = {https://europepmc.org/article/MED/42960201},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - BALF-mNGS-Derived Microbial Detection Profiles and Their Associations with Clinical Severity in Immunocompromised Patients with Community-Acquired Pneumonia.
AU - Liying Luo
AU - Junjie Zhao
AU - Jiancheng Zhuge
AU - Honglong Fang
AU - Lingmin Yuan
AU - Jianfei Wang
AU - Zhidan Hua
AU - Yidan Cui
PY - 2026
DA - 2026/10/25
JO - Infection and drug resistance
DO - 10.2147/idr.s657668
UR - https://europepmc.org/article/MED/42960201
AB - Background Immunocompromised patients with community-acquired pneumonia (CAP) have heterogeneous pulmonary microbial profiles and frequently experience a severe clinical course. Whether bronchoalveolar lavage fluid metagenomic next-generation sequencing (BALF-mNGS)-derived microbial features are associated with clinical severity in this population remains unclear.Objective To characterize pulmonary microbial features in immunocompromised patients with CAP and evaluate their association with ICU admission and length of hospital stay (LOHS).Methods This multicenter retrospective study included 1072 patients with CAP who underwent BALF-mNGS at five hospitals (August 2021-June 2025), including 362 immunocompromised and 710 immunocompetent patients. Microbial diversity, composition, and differentially enriched taxa were compared by immune status. Among immunocompromised patients, taxon-outcome associations were assessed using adjusted logistic and negative binomial regression, with sensitivity analyses additionally adjusting for antibiotic and antifungal exposure before BALF.Results Immunocompromised patients had higher alpha diversity (P<0.001), with limited overall community separation. Five taxa were enriched: Burkholderia multivorans, Klebsiella pneumoniae, Candida glabrata, Candida tropicalis, and Streptococcus pseudopneumoniae. In primary analyses, B. multivorans abundance was associated with ICU admission (adjusted odds ratio [aOR] 1.400, 95% CI 1.088-1.801; false discovery rate [FDR]-adjusted P=0.045) and longer LOHS (adjusted incidence rate ratio [aIRR] 1.108, 95% CI 1.036-1.186; FDR-adjusted P=0.014). C. glabrata was associated with longer LOHS (aIRR 1.101, 95% CI 1.023-1.185; FDR-adjusted P=0.026). K. pneumoniae showed a nominal ICU association that did not survive FDR correction (FDR-adjusted P=0.084). After additional adjustment for antibiotic and antifungal exposure, the associations of B. multivorans and C. glabrata with longer LOHS remained significant (both FDR-adjusted P=0.044), whereas the association between B. multivorans and ICU admission did not (FDR-adjusted P=0.168).Conclusion BALF-mNGS-derived microbial features showed limited overall community differences but distinct taxon-specific associations with clinical severity. These exploratory findings require further validation before their prognostic or clinical utility can be established.
SN - 1178-6973
ER -