{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:46:27Z","timestamp":1785732387666,"version":"3.56.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early initiation of targeted antifungal therapy is critical for improving outcomes in neutropenic patients with invasive pulmonary aspergillosis (IPA) in the intensive care unit (ICU). Although metagenomic next-generation sequencing (mNGS) is valuable for pathogen detection, its clinical value in IPA patients with neutropenia remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective study included patients clinically diagnosed with invasive pulmonary aspergillosis (IPA). All patients underwent both conventional microbiological tests (CMTs) and metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF). Based on neutrophil status, patients were stratified into neutropenic and non-neutropenic groups and further divided into mNGS-guided and CMT-guided groups according to the antifungal treatment strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>mNGS demonstrated higher pathogen detection rate than conventional microbiological tests (CMTs) in both neutropenic and non-neutropenic patients with invasive pulmonary aspergillosis (IPA). It also identified a broader pathogen spectrum and a higher proportion of mixed infections. Overall, IPA patients in the mNGS-guided group had lower 28-day mortality compared with the CMT-guided group (23.17% vs. 43.75%, P\u00a0=\u00a00.04). Multivariate analysis indicated that mNGS-guided therapy was associated with reduced 28-day mortality (adjusted OR\u00a0=\u00a00.329, 95% CI: 0.111\u20130.974, P\u00a0=\u00a00.045). A significant interaction between treatment strategy and neutrophil status was observed (adjusted P\u00a0=\u00a00.002). In subgroup analysis, the survival benefit of mNGS-guided therapy was mainly observed in neutropenic IPA patients, who achieved higher rates of appropriate antifungal therapy and lower mortality, whereas no significant intergroup difference was found among non-neutropenic IPA patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>mNGS-guided antifungal therapy significantly reduced 28-day mortality in neutropenic IPA patients, whereas no clear effect was observed in non-neutropenic patients. These findings highlight the potential clinical value of mNGS in guiding antifungal therapy in neutropenic IPA patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1878097","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:27:56Z","timestamp":1785731276000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The clinical application of metagenomic next-generation sequencing for invasive pulmonary aspergillosis in neutropenic patients: a multicenter retrospective study in the ICU"],"prefix":"10.3389","volume":"16","author":[{"given":"Jing","family":"Tang","sequence":"first","affiliation":[{"name":"Jin Hua Graduate Joint Training Base, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahao","family":"Deng","sequence":"additional","affiliation":[{"name":"Jin Hua Graduate Joint Training Base, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Guo","sequence":"additional","affiliation":[{"name":"Jin Hua Graduate Joint Training Base, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Song","sequence":"additional","affiliation":[{"name":"Jin Hua Graduate Joint Training Base, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjie","family":"Zhao","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People\u2019s Hospital (Affiliated People\u2019s Hospital, Hangzhou Medical College)","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojing","family":"Zhang","sequence":"additional","affiliation":[{"name":"WillingMed Technology Beijing Co., Ltd","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youqin","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, People\u2019s Hospital of Changshan County","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingmin","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Longyou County People\u2019s Hospital","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Quzhou Kecheng People\u2019s Hospital","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Canhu","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Jiangshan People\u2019s Hospital","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People\u2019s Hospital","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honglong","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People\u2019s Hospital","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiancheng","family":"Zhuge","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Quzhou Hospital of Traditional Chinese Medicine","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S121","DOI":"10.1093\/cid\/ciaa1751","article-title":"EORTC\/MSGERC definitions of invasive fungal diseases: summary of activities of the intensive care unit working group","volume":"12","author":"Bassetti","year":"2020","journal-title":"Clin. 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