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Background: Metagenomic next-generation sequencing (mNGS) was suggested to potentially replace traditional microbiological methodology because of its comprehensiveness. However, clinical experience with application of the test is relatively limited. Methods: From April 2017 to December 2017, 511 specimens were collected, and their retrospective diagnoses were classified into infectious disease (347 67. 9%), noninfectious disease (119 23. 3%), and unknown cases (45 8. 8%). The diagnostic performance of pathogens was compared between mNGS and culture. The effect of antibiotic exposure on detection rate was also assessed. Results: The sensitivity and specificity of mNGS for diagnosing infectious disease were 50. 7% and 85. 7%, respectively, and these values outperformed those of culture, especially for Mycobacterium tuberculosis (odds ratio OR, 4 95% confidence interval CI, 1. 7-10. 8; P <. 01), viruses (mNGS only; P <. 01), anaerobes (OR, ∞ 95% CI, 1. 71-∞; P <. 01) and fungi (OR, 4. 0 95% CI, 1. 6-10. 3; P <. 01). Importantly, for mNGS-positive cases where the conventional method was inconclusive, 43 (61%) cases led to diagnosis modification, and 41 (58%) cases were not covered by empirical antibiotics. For cases where viruses were identified, broad-spectrum antibiotics were commonly administered (14/27), and 10 of 27 of these cases were suspected to be inappropriate. Interestingly, the sensitivity of mNGS was superior to that of culture (52. 5% vs 34. 2%; P <. 01) in cases with, but not without, antibiotic exposure. Conclusions: mNGS could yield a higher sensitivity for pathogen identification and is less affected by prior antibiotic exposure, thereby emerging as a promising technology for detecting infectious diseases.
Miao et al. (Sat,) studied this question.