What question did this study set out to answer?

This research aims to assess the diagnostic efficiency of mNGS compared to traditional blood cultures for detecting bloodstream infections in critically ill perioperative patients.

March 26, 2026

400: Performance of MNGS for Bloodstream Infections in Perioperative Critically Ill Patients

Key Points

This research aims to assess the diagnostic efficiency of mNGS compared to traditional blood cultures for detecting bloodstream infections in critically ill perioperative patients.
Conducted as a prospective, multi-center study.
Enrolled perioperative ICU patients from July 2020 to June 2023.
Collected blood samples for simultaneous mNGS and blood culture detection.
Compared pathogen detection rates and evaluated mNGS’s diagnostic value.
mNGS showed a 25.6% pathogen detection rate versus 9.6% for blood cultures.
Significant advantages in detecting Gram-negative bacteria, anaerobes, and fungi with mNGS.
Identified mixed-pathogen infections in 20% of mNGS-positive cases.
mNGS had a sensitivity of 85.9% and specificity of 80.6%, indicating strong diagnostic capabilities.

Abstract

Introduction: Bloodstream infections (BSI) in intensive care unit (ICU) patients are associated with high morbidity and mortality, necessitating rapid and accurate pathogen identification to guide early antimicrobial therapy. However, traditional blood culture (BC) is limited by the long turnaround time and low sensitivity. Metagenomic next-generation sequencing (mNGS) has been applied in infectious disease diagnostics, but its clinical utility for perioperative ICU patients with BSI requires further evaluation. Methods: This prospective, multi-center diagnostic study enrolled perioperative ICU patients suspected of BSIs from July 2020 to June 2023. Blood samples were collected for mNGS and BC detection simultaneously. The study compared pathogen detection differences between the two methods, and evaluated the diagnostic value of mNGS for clinical BSI based on mNGS-assisted clinical diagnostic criteria. Additionally, the impact of mNGS findings on clinical antimicrobial management was assessed. Results: mNGS demonstrated a higher overall pathogen detection rate than BC in the 219 enrolled patients (25.6% vs. 9.6%, p < 0.001), with significant advantages in detecting Gram-negative bacteria (13.2% vs. 5.9%, p = 0.009), anaerobes (3.6% vs. 0.5%, p = 0.018), and fungi (6.4% vs. 0.9%, p = 0.002). Mixed-pathogen infections were identified in 20% of mNGS-positive clinical BSI cases, whereas BC-positive cases exclusively had single-pathogen infections. Ultimately, 64 patients (29.2%) were diagnosed with clinical BSIs. The sensitivity and specificity of the mNGS were 85.9% (95% CI: 74.5%–93.0%), and 80.6% (95% CI: 73.4%–86.4%), respectively, and the area under the receiver operating characteristic curve was 0.833 (95% CI: 0.772–0.894). Additionally, mNGS led to a positive impact in 56 patients (25.6%), manifested by the identification of new pathogens and guidance for targeted therapy, a negative impact in 11 patients (5.0%), and no clinical impact in 152 patients (69.4%). Conclusions: For perioperative ICU patients, mNGS demonstrated superior pathogen detection rates, broader microbial spectrum coverage, and enhanced polymicrobial infection detection capability versus BC. mNGS exhibited high diagnostic value for clinical BSI, with the potential to facilitate targeted antimicrobial therapy adjustments.

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