The impact of pt-NGS technology on antimicrobial use and outcomes in patients with lower respiratory tract infections: a hospital-based real-world study

This study aimed to evaluate the impact of pathogen-targeted next-generation sequencing (pt-NGS) technology on antimicrobial use and clinical outcomes in hospitalized adults with lower respiratory tract infections (LRTIs). In this retrospective cohort study, 340 adult LRTI patients were stratified into two groups: a pt-NGS-guided group (n = 140) and a conventional microbiological testing-guided group (n = 200). Outcomes included pathogen detection rates, antimicrobial therapy adjustments, clinical outcomes (mortality, length of stay LOS, ICU admission), and healthcare costs. Statistical analyses utilized t-tests, Mann-Whitney U tests, and multivariable regression. The pt-NGS group exhibited significantly higher pathogen detection rates (90.9%vs. 52.5%, P < 0.001) and a greater proportion of antimicrobial regimen adjustments (38.0%vs.16.7%, P = 0.013). Clinically, the pt-NGS group exhibited a shorter median duration of inappropriate antibiotic therapy (3.5vs.6days, P = 0.012), reduced hospital LOS and costs(23vs.38days, P = 0.024)/(CN¥26,548 vs. CN¥31,827, P = 0.026),and lower ICU admission rates (30.1% vs. 49.6%, P = 0.016), Mortality did not differ significantly between groups (4.68% vs. 6.10%, P = 0.382). pt-NGS technology enhances diagnostic precision, accelerates targeted antimicrobial therapy, and reduces unnecessary broad-spectrum antibiotic exposure, thereby improving clinical outcomes and resource utilization in LRTI management. Notably, no significant mortality benefit was observed, and broad-spectrum antimicrobial use increased in the pt-NGS group. These findings underscore its potential as a valuable tool supporting of antimicrobial stewardship programs in severe respiratory infections.