# Optimizing treatment administration strategies using negative mNGS results in corticosteroid-sensitive diffuse parenchymal lung diseases

## TL;DR

This study shows how negative mNGS results can guide treatment decisions in lung disease patients by confirming non-infection and adjusting corticosteroid use.

## Contribution

The study demonstrates the clinical utility of negative mNGS results in adjusting antibiotic and corticosteroid treatments in corticosteroid-sensitive lung diseases.

## Key findings

- Negative mNGS results led to discontinuation of antibiotics in 79.4% of patients.
- 70.7% of patients adjusted corticosteroid administration after receiving negative mNGS results.
- Lung microbiota composition correlated with disease severity markers like oxygenation index and pleural effusion.

## Abstract

Timely adjustments of antibiotic and corticosteroid treatments are vital for patients with diffuse parenchymal lung diseases (DPLDs). In this study, 41 DPLD patients with negative metagenomic next-generation sequencing (mNGS) results who were responsive to corticosteroids were enrolled. Among these patients, about 26.8% suffered from drug-induced DPLD, while 9.8% presented autoimmune-related DPLD. Following the report of the negative mNGS results, in 34 patients with complete antibiotics administration profiles, 79.4% (27/34) patients discontinued antibiotics after receiving negative mNGS results. Moreover, 70.7% (29/41) patients began or increased the administration of corticosteroid upon receipt of negative mNGS results. In the microbiota analysis, Staphylococcus and Stenotrophomonas showed higher detection rates in patients with oxygenation index (OI) below 300, while Escherichia and Stenotrophomonas had higher abundance in patients with pleural effusion. In summary, our findings demonstrated the clinical significance of mNGS in assisting the antibiotic and corticosteroid treatment adjustments in corticosteroid-responsive DPLD. Lung microbiota may imply the severity of the disease.

•Negative mNGS results can effectively confirm patients’ non-infected status•Negative mNGS results can prompt timely corticosteroid administration and adjustment•Lung microbiota may imply the severity of DPLD patients

Negative mNGS results can effectively confirm patients’ non-infected status

Negative mNGS results can prompt timely corticosteroid administration and adjustment

Lung microbiota may imply the severity of DPLD patients

Medical microbiology; Pharmacology; Cancer