The diagnostic efficacy of metagenomic next-generation sequencing (mNGS) in pathogen identification of pediatric pneumonia using bronchoalveolar lavage fluid (BALF): A systematic review and meta-analysis

Objective: This meta-analysis evaluates and compares the diagnostic efficacy of metagenomic next-generation sequencing (mNGS) with conventional microbiological tests (CMTs) in diagnosing pediatric pneumonia using bronchoalveolar lavage fluid (BALF). Methods: Data were sourced from Embase, PubMed, Web of Science, and the Cochrane Library. The pooled positive detection rate (PDR) of pathogens was estimated using fixed-effects or random-effects models. Subgroup analyses explored factors influencing mNGS diagnostic performance. Data analysis was conducted using Review Manager (RevMan) 5.4 and Stata version 16.0. Results: The pooled PDR of mNGS was 85.83 %, which is higher than the pooled PDR of 49.97 % for CMTs. A random-effects model indicated that, compared to CMTs, mNGS has a significantly higher PDR in pediatric pneumonia (OR = 3.99, 95 %CI: 2.12-7.50, P G 0.0001, I2 = 81 %). Subgroup analysis indicated that mNGS exhibited greater advantages in the group using the QIAamp kit (OR = 5.55, 95 % CI: 3.03-10.16, P G 0.00001), the group using the Illumina Nextseq platform (OR = 4.87, 95 % CI: 2.97-7.99, P G 0.00001), the DNA-only mNGS group (OR = 4.54, 95 % CI: 2.73-7.54, P G 0.00001), and the non-severe pneumonia group (OR = 4.76, 95 % CI: 3.51-6.46, P G 0.00001). However, when the subgroups were categorized as mixed infections or single-pathogen infections, no statistically significant differences were observed (Mixed: OR = 1.77, 95 % CI: 0.30-10.56, P = 0.53; Single: OR = 3.97, 95 % CI: 0.42-37.87, P = 0.23) Conclusion: mNGS demonstrates high diagnostic efficacy in detecting pathogens in BALF from pediatric patients with pneumonia. The diagnostic stability of mNGS is influenced by sample extraction, sequencing platforms, positive interpretation criteria, and disease status. Standardized procedures and technologies can enhance mNGS diagnostic performance.