Impact of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid on antimicrobial stewardship

Reviewed by: Dr. Michael Payne, MD; London Health Sciences Centre

The impact of mNGS results from clinical specimens on antimicrobial stewardship requires further study. This retrospective cohort study included bronchoalveolar lavage (BAL) samples from patients diagnosed with lower respiratory tract infections (LRTIs). Individuals with mNGS and conventional microbiologic tests were classified as mNGS group, while patients only with conventional tests were included as a control group. A total of 306 patients were included, with 153 in each group. mNGS was associated with lower rates of antibiotic escalation than control group, however there was no significant association with antibiotic de-escalation. Compared to the control group, more mNGS patients discontinued the use of antivirals. The use of mNGS was associated with lower rates of antibiotic escalation and may contribute to the discontinuation of antivirals, but mNGS did not contribute to antibiotic de-escalation. This may be attributable to the difficulty interpreting the clinical significance of multiple organisms are identified/reported with mNGS, along with the lack of antimicrobial susceptibility data, which is often required for de-escalation.

The Journal of Infectious Diseases, jiad296, July 28, 2023.

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