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Metagenomic Next-Generation Sequencing Versus Conventional Microbiological Tests for Pathogen Identification and

Lin Zheng1, Xu Wang1, Jiaxin Li1

  • 1Department of PICU, Pediatric Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science and Peiking Union Medical College, Beijing 100037, China.

Journal of Clinical Medicine
|July 28, 2026
PubMed

Insights

Next-generation sequencing (NGS) significantly improves pathogen detection in pediatric post-cardiac surgery infections compared to conventional tests. Polymicrobial infections are linked to worse outcomes, highlighting NGS

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease diagnostics
  • Molecular microbiology

Background:

  • Postoperative infections are a major threat in pediatric cardiac surgery, leading to sepsis, organ dysfunction, and increased mortality.
  • Conventional microbiological tests (CMT) have limitations in sensitivity, speed, and detecting diverse pathogens like viruses and polymicrobial agents.
  • Next-generation sequencing (NGS) offers a potential advancement for more comprehensive pathogen identification.

Purpose of the Study:

  • To compare the diagnostic accuracy of mNGS against CMT for postoperative infections in pediatric cardiac surgery patients.
  • To investigate the clinical impact of polymicrobial infections on patient outcomes.
  • To analyze pathogen spectrum and antimicrobial resistance patterns.

Main Methods:

  • Retrospective cohort study of 4889 pediatric patients in the PICU post-cardiac surgery.
  • Analysis of 879 CMT specimens and 86 mNGS specimens from 510 infected patients.
  • Comparison of pathogen detection rates, spectrum, antimicrobial resistance, and clinical outcomes (ventilation duration, ICU stay, CRRT).

Main Results:

  • mNGS demonstrated a significantly higher overall pathogen detection rate (79.1%) than CMT (56.5%).
  • mNGS excelled in detecting viruses (37.2% vs. 5.8%) and polymicrobial infections (38.2% vs. 5.4%).
  • Polymicrobial infections correlated with longer mechanical ventilation, extended PICU stay, and increased CRRT use.

Conclusions:

  • mNGS is a more sensitive and comprehensive diagnostic tool for pediatric post-cardiac surgery infections, particularly for viral and polymicrobial cases.
  • Polymicrobial infection is an independent risk factor for adverse clinical outcomes in this population.
  • Routine mNGS use can guide targeted antimicrobial therapy and improve patient prognosis.

Keywords:
metagenomic next-generation sequencingpathogen detectionpediatric cardiac surgerypolymicrobial infectionpostoperative infection

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