Efficacy of targeted next generation sequencing for pathogen detection in lower respiratory tract infections.

Objective: To investigate the diagnostic utility of targeted next-generation sequencing (tNGS) in the diagnosis of lower respiratory tract infections.

Methods: Patients with lower respiratory tract infection in East Area of Yantai Yantaishan Hospital from December 2021 to September 2023 were retrospectively analyzed. Sputum samples were tested using both tNGS technology and conventional microbiological examination. Data were collected on general clinical features and test outcomes. The study evaluated the efficacy of tNGS by comparing its positive detection rate against traditional methods and analyzing detection differences among patients with varying clinical characteristics. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic accuracy of both testing methods.

Results: A total of 281 patients were included, with corresponding sputum specimens. The tNGS method showed a higher positivity rate of 90.0%, significantly outperforming the conventional method's rate of 70.82% (P<0.05). Among 199 patients with concordant positive results, 38.22% fully agreed, while 53.40% completely disagreed between the two methods. Mycobacterium tuberculosis, Candida albicans, and Pseudomonas aeruginosa were the most frequently detected pathogens, respectively. tNGS significantly reduced the time required for pathogen detection (P<0.001) and identified a higher rate of mixed infections compared to conventional methods (49.11% vs 2.85%, P<0.001). Positive tNGS detection rates significantly differed between patients with abnormal vs normal C-reactive protein or procalcitonin levels. The AUC for tNGS was 0.867, indicating superior diagnostic accuracy over the conventional method (P<0.05).

Conclusions: tNGS technology demonstrates a high positivity rate and rapid pathogen detection in lower respiratory tract infections, with notable advantages in identifying mixed infections. This method shows potential for enhancing diagnostic accuracy and treatment decisions in clinical settings.