Clinical diagnostic value of targeted next generation sequencing for lower respiratory tract infection: a retrospective study.

OBJECTIVE

Lower respiratory tract infections (LRTIs) progress swiftly and require timely, accurate pathogen detection to enhance patient outcomes. This study aims to utilize the targeted metagenomic next-generation sequencing (tNGS) technology as a novel approach to investigate the types of pathogens involved in infections following different structural lung diseases.

METHODS

This retrospective cohort study enrolled 329 patients with suspected LRTIs admitted to three medical centers from June 2023 and June 2024. The study analyzed the pathogenic spectrum of lung infections and compared the diagnostic outcomes of tNGS with those of conventional microbiological techniques (CMTs).

RESULTS

tNGS demonstrated significantly higher sensitivity (97.8% vs. 28.9%, p<0.05) and accuracy (96.6% vs. 30.3%, p<0.05) than CMTs, along with a high concordance rate (87.8%) with clinically confirmed pathogens. Pathogen profiling revealed that Mycoplasma pneumoniae (21.88%), Aspergillus fumigatus (5.17%), and influenza A virus subtype H3N2 (13.07%) were the predominant bacterial, fungal, and viral pathogens, respectively. Several key pathogens, including Pseudomonas aeruginosa, Haemophilus influenzae, Nocardia abscessus, Aspergillus fumigatus, Influenza A virus H3N2, and Influenza B virus, were detected more frequently in the SLD group than in the non-SLD group. Among 193 patients whose treatment was adjusted based on tNGS results, 35.2% initiated new treatment regimens, 25.4% continued their original treatment, and 7.3% required treatment escalation, with 90.2% of these patients showing clinical improvement.

CONCLUSION

These findings showed that tNGS demonstrates significant promise for the etiological diagnosis and tailored management of LRTIs.