Next-Generation Sequencing in Melioidosis: Enhancing Diagnosis, Epidemiology and Antimicrobial Resistance Surveillance.

Melioidosis, caused by Burkholderia pseudomallei, is a severe infectious disease with high mortality. Diagnostic delays due to conventional culture and serology limitations impact patient outcomes. This narrative review synthesizes evidence on next-generation sequencing (NGS) in melioidosis. NGS technologies encompass two main applications: metagenomic NGS (mNGS), which enables culture-independent detection directly from clinical samples, and whole-genome sequencing (WGS), which provides outbreak tracing and source attribution from cultured isolates. Resistance profiling detects antimicrobial resistance (AMR) determinants (e.g., penA mutations) to guide therapy. Recent 2025-2026 studies highlight new applications, including direct pathogen genome recovery from environmental samples. Despite cost and standardization challenges, integrating NGS into clinical workflows holds promise for improving melioidosis management, especially in resource-limited settings.