Diagnostic and Clinical Value of Targeted Next‐Generation Sequencing for Pediatric Respiratory Infections in Northern China

BACKGROUND: Pediatric patients are particularly susceptible to respiratory tract infections (RTIs) due to ongoing maturation of pulmonary and immune function, highlighting the need for rapid and accurate pathogen identification. Although targeted next-generation sequencing (tNGS) is increasingly applied in infectious disease diagnostics, its real-world clinical utility in pediatric RTIs remains underexplored. METHODS: We conducted a retrospective study of 940 hospitalized children with RTIs in northern China between April and December 2023. All patients underwent tNGS alongside conventional microbiological tests (CMTs), including PCR, culture, and serology. Diagnostic performance metrics-including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)-were calculated. The clinical impact of tNGS was assessed by examining treatment adjustments, turnaround time (TAT), and patient outcomes. RESULTS: tNGS demonstrated superior diagnostic performance compared with CMTs: sensitivity 91.38% versus 29.68%, specificity 91.03% versus 90.17%, PPV 97.68% versus 77.78%, and NPV 73.39% versus 54.60%. tNGS identified a broader spectrum of pathogens, including RNA viruses and low-abundance organisms frequently missed by CMTs, and detected polymicrobial infections in 17.77% of cases versus 1.17% by CMTs. Based on tNGS, treatment was escalated in 35.32% and de-escalated in 29.04% of patients, with over 90% of adjustments made within 48 h, facilitated by a mean TAT of 28.5 h. Clinical improvement was observed in most adjusted cases. Pathogen distribution showed age- and season-specific patterns, underscoring the need for context-informed diagnostics and therapy. CONCLUSION: tNGS enhances pathogen detection accuracy in pediatric RTIs, enables timely and appropriate treatment modifications, and supports antimicrobial stewardship. Its high sensitivity, rapid TAT, and capacity to identify co-infections reinforce its clinical utility in guiding optimized management of pediatric respiratory infections.