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

Objectives: Controversy exists regarding the benefits of metagenomic next-generation sequencing (mNGS) in lower respiratory tract infections (LRTIs). We assessed the impact of mNGS on the treatment and prognosis of LRTI patients through a systematic review and meta-analysis.

Methods: A literature search was conducted in PubMed, Embase and CENTRAL databases up to February 19, 2024. Studies investigating the clinical value of mNGS in patients with LRTIs were included. The Risk-of-Bias Tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies were used to assess risk of bias. Antibiotic change rates and prognostic outcomes were evaluated using random-effects analyses with 95% confidence intervals (CIs). This study is registered with PROSPERO, CRD42024509738.

Results: 12 studies were included in the meta-analysis. The use of mNGS was associated with a higher rate of antibiotic change (odds ratio [OR], 2.47; 95% CI, 1.42-4.28; P < 0.01). Consistent findings were observed in adults, patients with severe LRTIs, and in those who underwent mNGS testing exclusively on bronchoalveolar lavage fluid. We also observed a reduction in in-hospital mortality (OR, 0.49; 95% CI, 0.36-0.67; P < 0.01), though no significant impact on length of hospital stay was observed (mean difference [MD], -1.79; 95% CI, -5.20 -1.63; P = 0.31).

Conclusions: This meta-analysis indicates that the application of mNGS may lead to changes in antibiotic prescriptions for patients with LRTIs, and might reduce the risk of mortality. However, large-scale randomized controlled clinical trials are urgently needed to validate the findings of this study.