In ICU-infected patients, metagenomic next-generation sequencing showed higher positive detection rates than conventional microbiological testing.

This retrospective cohort study assessed the diagnostic performance of metagenomic next-generation sequencing (mNGS) compared to conventional microbiological testing (CMT) in a population of 156 ICU-infected patients. The primary outcome measured positive detection rates and clinical concordance, while secondary outcomes included the detection of antimicrobial resistance genes (ARGs), virulence factors, and the rate of mixed infections.

Results indicated that mNGS achieved a higher positive detection rate of 89.7% compared to 67.3% for CMT (P < 0.001). Clinical concordance was also significantly higher with mNGS at 75.6% versus 35.9% for CMT (P < 0.001). Additionally, mNGS detected a mixed-infection rate of 72.1% and identified ARGs in 49.0% of bacterial infections. Based on ARG detection, antimicrobial therapy was adjusted in 47.4% of cases, showing 72.0% concordance with phenotypic susceptibility.

The study noted that the integrative value of mNGS in simultaneously revealing resistance, virulence, and host-response interplay in ICU-infected patients remains underexplored. Safety data regarding adverse events or discontinuations were not reported. While mNGS offers a comprehensive diagnostic tool by integrating pathogen identification with resistance and virulence profiling, clinicians should interpret these findings conservatively given the observational nature of the study and the limited exploration of its full integrative utility.