Precision management of community-acquired pneumonia in children: An applied study combining traditional detection of alveolar lavage fluid pathogenesis with multiplexed targeted nanopore sequencing

This study aimed to evaluate the efficacy of traditional alveolar lavage fluid pathogenicity detection methods and multiplexed targeted nanopore sequencing (NTS) in identifying pathogens in children with community-acquired pneumonia. Additionally, we analyzed serological characteristics by pathogen type to inform future precision treatment strategies. We retrospectively analyzed data from 251 children (aged < 14 years) diagnosed with pneumonia between June 2024 and January 2025 at the Department of Pediatric Internal Medicine, Shaoxing People's Hospital. Bronchoalveolar lavage fluid samples were collected via fiberoptic bronchoscopy. Pathogen detection was performed using routine bacterial culture, polymerase chain reaction, and NTS. Serological tests, including white blood cell count, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH), and erythrocyte sedimentation rate, were also conducted, and the results were analyzed statistically. Pathogens were detected in 94.42% of the children with pneumonia (237/251). Mycoplasma infections were found in 72.38% of children over 6 years of age, while bacterial infections were more prevalent in children under 6 years. Among 53 cases tested concurrently, the bacterial detection rate of NTS was 37.74%, significantly higher than that of conventional culture (18.87%, P < .05). Significant differences in serological markers were observed between children infected with different pathogens. Specifically, leukocyte count and PCT were lower in the mycoplasma-infected group than in the non-mycoplasma-infected group, while D-dimer and LDH levels were higher (P < .05). This study demonstrated that NTS significantly improved the pathogen detection rate in children with community-acquired pneumonia, particularly in cases of complicated infections, compared to traditional detection methods. Additionally, significant differences in serological markers among children infected with different pathogens were identified, providing valuable insights for clinical diagnosis and treatment. The integration of traditional diagnostic methods with NTS technology may improve diagnostic accuracy, though its impact on clinical management requires further validation.