Primary exploring the value of metagenomic next‐generation sequencing in detecting pathogenic bacteria of cholangitis with biliary atresia after Kasai operation

Purpose: To evaluate the value of metagenomic next-generation sequencing (mNGS) in detecting pathogenic bacteria of cholangitis for patients with biliary atresia after Kasai operation. Methods Patients of biliary atresia with cholangitis after Kasai operation who were admitted to Xi'an Children's Hospital from July 2019 to December 2021 were retrospectively analyzed. Both blood culture and mNGS were carried out in all of these patients. The detection rate of pathogenic bacteria, pathogenic bacteria spectrum, test time, inflammatory indicators and liver function were compared. The correlation between drug resistance gene and drug resistance phenotype was analyzed. All the patients were followed up for 0.5-3 years to evaluate the onset of cholangitis and the survival status of autologous liver. Results a total of 30 episodes of cholangitis in 25 patients were included in this study. There were significant differences in the detection rate of pathogenic bacteria [23.3 vs.73.3%, P < 0.05] and the test time [120 (114.5–120) vs.16 (16–21) h, P < 0.001] between the blood culture and mNGS. Inflammatory indicators (CRP, PCT) and liver function (TB, DB, GGT) were compared before and after anti-infection, and there was significant statistical difference with two methods. Four kinds of bacteria were detected by blood cultures, and 10 kinds of bacteria were detected by mNGS. The drug-resistant phenotypes and drug-resistant genotypes of 3 Klebsiella pneumoniae strains were compared, h Cholangitis occurred 3 times in 1 case (4%) and twice in 3 cases (12%). Autologous liver survived in 17 cases (68%). Conclusion Compared with traditional blood culture, mNGS is more efficient, convenient and accurate in the detection of pathogens. It provides a new method for the accurate detection of pathogenic bacteria of cholangitis with biliary atresia after Kasai operation.