Clinical metagenomic next-generation sequencing test for diagnosis of central nervous system infections in ICU: a multicenter retrospective study

BACKGROUND: Central nervous system (CNS) infections impose a substantial global burden of morbidity and mortality, necessitating accurate and timely diagnosis for optimal clinical management. Metagenomic next-generation sequencing (mNGS) has been demonstrated as a valuable tool for pathogen detection in patients with suspected CNS infections. METHODS: From December 2019 to June 2023, we conducted a comprehensive analysis of 520 cerebrospinal fluid samples collected from patients with suspected intracranial infections across six intensive care units. All pathogen-positive results identified through metagenomic next-generation sequencing were subsequently validated by an independent laboratory. RESULTS: Metagenomic NGS detected 105 microbial species in 520 clinical samples, comprising 64 bacterial species (61.0%), 16 DNA viruses (15.2%), 13 fungal species (12.4%), and 7 RNA viruses (6.7%). The 30-day mortality rate among all study participants was 18.5%. Metagenomic NGS identified 172 infection cases, whereas conventional culture methods detected only 31 cases. For CNS infections, mNGS demonstrated diagnostic sensitivity, specificity, and accuracy rates of 59%, 90.5%, and 72.5%, respectively. CONCLUSIONS: Metagenomic NGS testing facilitates accelerated diagnosis of CNS infections and informs evidence-based clinical management decisions.