Metagenomic next-generation sequencing on treatment strategies and prognosis of patients with lower respiratory tract infections: A systematic review and meta-analysis.

Summary

Across 12 studies, mNGS use in LRTIs increased antibiotic adjustments (OR 2.47) and was associated with lower in-hospital mortality (OR 0.49), with consistent benefit in adults, severe LRTI, and BALF-only testing; hospital length of stay was unchanged. Findings support incorporating mNGS into stewardship pathways for severe LRTIs.

Key Findings

• mNGS increased antibiotic change rates in LRTIs (OR 2.47; 95% CI 1.42–4.28).
• mNGS use was associated with reduced in-hospital mortality (OR 0.49; 95% CI 0.36–0.67).
• No significant effect on length of hospital stay (mean difference −1.79 days; 95% CI −5.20 to 1.63).
• Benefits were consistent in adults, severe LRTIs, and in studies using BALF-only testing.

Clinical Implications

Consider mNGS in severe or diagnostically uncertain LRTIs—especially using BALF—to guide targeted therapy and antimicrobial stewardship; integrate results into rapid MDT review to translate diagnostic gain into timely therapy changes.

Limitations

• Pooled evidence largely observational with heterogeneity in populations and mNGS platforms.
• Potential publication bias and limited RCT data; lack of standardized turnaround times.

Future Directions

Prospective multicenter RCTs integrating mNGS into care pathways (with predefined turnaround and action protocols) to confirm survival benefit and cost-effectiveness.