1788. The Utility of Next-Generation Sequencing for Detection of Candidate Pathogens in Bronchoalveolar Lavage Fluid from Pediatric Patients with Respiratory Failure

BACKGROUND: In the field of infectious diseases, identification of etiologic pathogen is essential for definitive diagnosis and decisions regarding appropriate management. Bronchoalveolar lavage fluid (BALF) is considered a sterile type of specimen that is suitable for detecting pathogens of respiratory infections. Recently, next-generation sequencing (NGS) has been applied in the field of infectious diseases and has enabled us to identify pathogenic microorganisms comprehensively. The aim of this study was to comprehensively identify pathogens using NGS in BALF samples from immunocompetent pediatric patients with respiratory failure. METHODS: Ten patients hospitalized in the pediatric intensive care unit with respiratory failure were included. BALF samples obtained in the acute phase were used to prepare DNA- and RNA-sequencing libraries. The libraries were sequenced on MiSeq, and the sequence data were analyzed using metagenome analysis tools. RESULTS: A mean of 2,041,216 total reads were sequenced for each library. A significant number of four types of bacterial reads was detected in three BALF samples with DNA-sequencing, whereas pathogenic respiratory viruses were detected in seven of 10 patients with RNA-sequencing.Candidate pathogens were detected in three patients in whom etiologic agents were not identified by conventional methods. A summary of the detected pathogens is listed in Table 1. Sequence coverage and depth of each reference bacterial and viral genome are shown in Figures 1 and 2, respectively. The complete genome of enterovirus D68 was identified in two patients without underlying diseases, and phylogenetic analysis suggested that both strains belong to subclade B3, which is an epidemic strain that has spread worldwide in recent years. CONCLUSION: We demonstrated the utility of the NGS-based approach for detection of candidate pathogens in BALF from pediatric patients with severe respiratory failure. Our results suggest that NGS can be applied for comprehensive molecular diagnostics as well as surveillance of pathogens in the field of infectious diseases. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.