Precision Metagenomics in Elder Care: Renovating Infection Diagnostics and Antimicrobial Stewardship

Antimicrobial resistance (AMR) remains a critical challenge in elder care, where frequent infections, polypharmacy, and immunosenescence contribute to poor outcomes. Traditional diagnostic methods, including culture-based and polymerase chain reaction assays, often fail to provide timely, comprehensive microbial identification, leading to prolonged empirical antibiotic use and worsening resistance trends. Precision metagenomics, a clinically refined application of next-generation sequencing, represents a transformative advancement in infection diagnostics and antimicrobial stewardship. By enabling culture-independent, high-resolution pathogen detection directly from clinical samples, precision metagenomics provides real-time identification of bacterial, viral, fungal, and parasitic pathogens, along with their antimicrobial resistance profiles. This approach facilitates early intervention, improves therapeutic precision, and minimizes unnecessary antibiotic exposure, particularly in long-term care facilities where multidrug-resistant organism outbreaks are prevalent. Additionally, the integration of non-invasive sample collection methods, such as diaper-derived urine and hydrogel-based wound dressings, enhances diagnostic accessibility for frail and cognitively impaired patients. As sequencing costs decline and bioinformatics pipelines become more efficient, the routine implementation of precision metagenomics in elder care settings will transition infection management from a reactive to a proactive paradigm. The synergy between precision metagenomics, artificial intelligence-driven clinical decision support systems, and real-time biosensors presents a novel framework for infection surveillance, offering a sustainable solution to combat AMR while optimizing patient outcomes. This paper explores the clinical applications, challenges, and future directions of precision metagenomics in elder care, emphasizing its role in redefining infection control and antibiotic stewardship.