This is a multicenter, randomized controlled trial designed to evaluate the impact of tNGS in patients with community-acquired pneumonia who experience initial treatment failure.
Community-acquired pneumonia (CAP) is a common respiratory disease and poses a major threat to global health. CAP can be caused by a wide range of respiratory pathogens, including viruses, bacteria, and fungi. However, conventional microbiological tests often fail to identify the causative pathogens, making etiological diagnosis challenging and limiting the implementation of individualized treatment strategies, which may affect patient prognosis. Targeted next-generation sequencing (tNGS) enables the simultaneous detection of hundreds of common respiratory pathogens at a relatively low cost and has significantly improved pathogen detection rates. To further evaluate the impact of tNGS on clinical decision-making and patient outcomes in real-world practice, a multicenter randomized controlled trial is proposed by the investigators, enrolling patients with community-acquired pneumonia who experience initial treatment failure. Participants will be randomly assigned in a 1:1 ratio to either the tNGS group or the conventional testing group. Patients in the tNGS group will undergo tNGS in addition to conventional microbiological testing, whereas those in the conventional testing group will receive conventional microbiological testing alone. Length of hospital stay and other clinical effectiveness endpoints will be compared between the two groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
524
Bronchoalveolar lavage fluid (BALF) or sputum samples will be collected within 72 hours after randomization and sent for targeted next-generation sequencing (tNGS). The test results will be reported to the attending physician within 1-2 days.
Bronchoalveolar lavage fluid (BALF) or sputum samples will be collected within 72 hours after randomization and sent for conventional microbiological testing. The type of conventional microbiological testing will be determined by the attending physician, and test results will be reported in approximately one week
A telephone visit will be conducted on or around Day 30 for study participants who are discharged or transferred to another hospital due to disease exacerbation, to collect information on survival, ICU admissions, mechanical ventilation, and medical costs.
China-Japan Friendship hospital
Beijing, Beijing Municipality, China
Length of hospital stay
Defined as the total number of hospital days by Day 30.
Time frame: 30 days
30-day mortality
Defined as the proportion of patients who died by Day 30.
Time frame: 30 days
ICU admission rate
Defined as the incidence of transfer to the ICU within 30 days of randomization for patients initially admitted to a general ward.
Time frame: 30 days
Length of stay in ICU
Defined as the total number of days a patient spends in the ICU within 30 days of randomization
Time frame: 30 days
Incidence of mechanical ventilation
Defined as the proportion of patients receiving mechanical ventilation by day 30.
Time frame: 30 days
Duration of mechanical ventilation
Defined as the total number of days a patient receives mechanical ventilation within 30 days of randomization.
Time frame: 30 days
5-Day Antibiotic Modification Rate
Defined as the proportion of patients who undergo antibiotic escalation or de-escalation within 5 days after randomization.
Time frame: 5 days
3-Day Antibiotic Modification Rate
Defined as the proportion of patients who undergo antibiotic escalation or de-escalation within 3 days after randomization.
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Time frame: 3 days
5-Day Other Antimicrobial Agents Modification Rate
Defined as the proportion of patients who initiate or discontinue other antimicrobial agents including antiviral, antifungal or antitubercular drugs within 5 days after randomization.
Time frame: 5 days
3-Day Other Antimicrobial Agents Modification Rate
Defined as the proportion of patients who initiate or discontinue other antimicrobial agents including antiviral, antifungal or antitubercular drugs within 3 days after randomization.
Time frame: 3 days
Cost of hospitalization
Defined as the total expenses incurred for hospitalization related to the current infection within 30 days of randomization."
Time frame: 30 days