Targeted next-generation sequencing (tNGS) has demonstrated higher analytical detection of respiratory pathogens than conventional microbiological tests (CMTs), yet its real-world clinical value in intensive care units (ICUs) remains uncertain. We conducted an interim analysis of a prospective study including 51 adult ICU patients with severe pneumonia at a tertiary medical center in Taiwan and examined the challenges to its routine implementation in the ICU. Bronchoalveolar lavage samples were analyzed using a hybrid capture–based Respiratory Pathogen ID/AMR Enrichment Panel (RPIP) and compared with standard testing (CMT combined with the FilmArray Pneumonia Panel FAPP). Causative pathogens were determined through multidisciplinary expert adjudication. RPIP showed a higher analytical detection rate than standard testing (90.2% vs. 82.4%). However, the proportion of adjudicated causative pathogens was similar between RPIP and standard testing (47.1% vs. 49.0%), with no significant difference (McNemar’s exact test, p = 1.00). After expert adjudication, RPIP provided additional clinically actionable yield in 23.5% of patients compared with CMT + FAPP, mainly related to antimicrobial resistance determinants, while 17.6% showed concordant results, 13.7% demonstrated lower yield with RPIP, and 45.1% of cases had no adjudicated causative pathogen after comprehensive review. Although tNGS broadens pathogen and resistance detection, its routine implementation in the ICU requires clearly defined indications, validated genotype–phenotype correlations, optimized turnaround time, strict contamination control, and structured multidisciplinary integration.
Tseng et al. (Thu,) studied this question.