Clinical research advances in pulmonary infections in 2025: a narrative review of multipathogen assessment, precision diagnosis, and integrated management.

Abstract

Background and objective: The diagnosis and treatment of pulmonary infections have become increasingly complex owing to antimicrobial resistance, the growing population of immunocompromised patients, and the ongoing circulation of respiratory viruses. In this narrative review, the major clinical advances reported in 2025 are summarised, and evidence-based support for multipathogen assessment, precision diagnosis, individualized treatment, and integrated management of pulmonary infections is provided.

Methods: PubMed, Web of Science, and the Chinese Medical Association Journal Database were searched for relevant English-language and Chinese-language publications. The search primarily focused on studies published in 2025 and was supplemented by the manual retrieval of relevant clinical studies and guidelines. Medical Subject Headings (MeSH) and free-text terms were used in PubMed, with corresponding free-text terms applied in the other databases. Clinically relevant publications were screened according to predefined criteria by two independent reviewers, and expert adjudication was used in the event of disagreements.

Key content and findings: Metagenomic next-generation sequencing (mNGS), integrated biomarker assessment, and artificial intelligence (AI) have exhibited increasing clinical value in pathogen identification, differential diagnosis, and prognostic assessment. Therapeutic advances have been reported for drug-resistant bacterial and fungal infections, as well as for coronavirus disease 2019 (COVID-19) and influenza, supporting more precise and individualized treatment. Studies on the gut-lung axis and immune modulation have further clarified the potential role of host-directed approaches, although clinical evidence for microbiota-targeted interventions remains limited. The risks associated with coinfection received increasing attention, while improved identification of risk factors and stratified management supported more individualized care for high-risk populations.

Conclusions: In 2025, the clinical management of pulmonary infections continued to transition towards precision-oriented and host-directed models. However, because a quantitative evidence synthesis was not included in this narrative review, pooled effect size estimates or formally graded clinical recommendations are not provided. The heterogeneity of the available studies also limits the overall strength and generalisability of the evidence. Future high-quality, multicentre studies are needed to further standardise clinical diagnosis and treatment strategies.