Routine Metagenomics Service for ICU Patients with Respiratory Infection
Authors' conclusion
This pilot study illustrates the potential of RMg testing to provide benefits for antimicrobial treatment, infection control, and public health when provided in a real-world critical care setting.
Study context
- Population
- ICU patients with suspected lower respiratory tract infection on two general and one specialist respiratory ICUs, Guy's and St Thomas' NHS Foundation Trust, London128 samples
- Participants
- 87 patients
- Comparison
- Respiratory metagenomics vs routine testing
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
| Group | Sensitivity | Specificity |
|---|---|---|
| Respiratory metagenomics (RMg) | 93% | 81% |
Respiratory metagenomics (RMg)
Sensitivity93%
Specificity81%
- Same-day results (first 15 weeks)
- 110 samples (86%)
- Median turnaround time
- 6.7 hours (IQR 6.1-7.5 h)
- RMg results informing antimicrobial prescribing changes
- 48%
- Escalation
- 22%
- Deescalation
- 26%
- Escalation based on speciation
- 20 out of 24
- Escalation based on acquired-resistance genes
- 4 out of 24
Further findings
Fastidious or unexpected organisms
- Samples with fastidious or unexpected organisms
- 21
- Anaerobes
- 12
- Also M. tuberculosis, T. whipplei, cytomegalovirus, Legionella pneumophila ST1326 (subsequently isolated from bedside water outlet)
Consecutive severe community-acquired lower respiratory tract infection (LRTI)
- S. aureus with SCCmec
- 2
- S. aureus with luk F/S virulence determinants
- 3
- Also S. pyogenes (emm1-M1uk), S. dysgalactiae subsp. equisimilis (STG62647A), Aspergillus fumigatus, with multiple treatment and public health impacts
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Routine Metagenomics Service for ICU Patients with Respiratory Infection. Am J Respir Crit Care Med. Published 15 January 2024. doi:10.
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