Abstarct:

The swift and accurate identification of pathogens is essential for the effective management of infectious diseases. Traditional microbiological methods, though fundamental, often suffer from long turnaround times, limited sensitivity for fastidious or new organisms, and are impacted by prior antibiotic use. Metagenomic next-generation sequencing (mNGS) marks a significant shift by offering a culture-independent, hypothesis-free method for pathogen detection. This review compiles findings from recent studies, focusing on a 2024 retrospective analysis by Zhang et al., to critically assess mNGS's clinical use. The study shows that mNGS provides much higher sensitivity (78.05% vs. 24.39%) compared to culture, though it compromises on specificity (66.67% vs. 100.0%). Its greatest benefit is in diagnosing difficult infections, such as those from rare, new, or unculturable pathogens, and in directing treatment for immunocompromised patients. However, issues remain like distinguishing colonization from infection, interpreting background microbial signals (e.g., Epstein-Barr virus, Cytomegalovirus), and dealing with false negatives due to low pathogen presence. The review concludes that mNGS is an essential supplementary tool in clinical microbiology, especially for complex cases, although its findings should be carefully considered within the complete clinical scenario. Future efforts should aim at standardizing procedures, enhancing bioinformatic filtering, and performing large-scale prospective research to confirm its place in routine diagnostics.