Comparative Evaluation of mNGS and Traditional Culture Methods in Pathogen Detection for Pulmonary Infections

Purpose This study aimed to evaluate the diagnostic accuracy and clinical applicability of metagenomic next-generation sequencing (mNGS) in pulmonary infections by comparing it with traditional culture methods in a Traditional Chinese Medicine (TCM) hospital setting. Methods This retrospective cohort study enrolled 67 consecutively admitted patients with radiologically and clinically confirmed pulmonary infections from the Department of Respiratory Infectious Diseases at Xinchang Hospital of Traditional Chinese Medicine between December 2022 and September 2024. Clinical specimens included blood, bronchoalveolar lavage fluid (BALF), sputum, hydrothorax and cerebrospinal fluid (CSF). mNGS and conventional culture were performed to compare detection rates and microbial community profiles. Results Among 67 cases, mNGS identified pathogens in 89.55% (60/67), compared to 20.90% (14/67) by traditional culture. Of 14 dual-positive cases, only 1 (1/14, 7.14%) showed complete concordance, while most exhibited discordance or partial genus-level overlap. mNGS further detected viral co-infections in 44.78% (30/67) and identified fastidious/non-culturable pathogens such as enterovirus, human herpesvirus type 1, and Mycobacterium tuberculosis . Patients with chronic diseases were more susceptible to EB virus infections. Conclusion mNGS significantly enhances pathogen detection in pulmonary infections, supports targeted antimicrobial therapy, and holds potential for contributing to clinical outcomes and reducing antibiotic resistance.