Pathogen-oriented targeted next-generation sequencing as an adjunctive tool for detection of pathogens in endophthalmitis: a retrospective clinical evaluation

Background: Endophthalmitis represents one of the most severe ophthalmic emergencies, requiring prompt etiological identification to enable tailored antibiotic administration. Conventional identification methods, such as ocular sample culture, exhibit limited positivity in endophthalmitis, necessitating more advanced approaches. Methods: The performance of pathogen-oriented targeted next-generation sequencing (tNGS), designed to capture a predefined panel of 207 clinically relevant pathogens, was retrospectively evaluated in 43 patients with endophthalmitis. Results: = 0.666). The application of tNGS impacted therapeutic strategy selection and contributed to the control of infections in cases caused by uncommon pathogens (e.g., mycobacterial infection), in endogenous endophthalmitis, and particularly in fungal endophthalmitis. Conclusion: The higher positivity and shorter turnaround time of pathogen-oriented tNGS render it an adjunctive tool for enhancing pathogen identification in endophthalmitis. We recommend the routine application of tNGS as a valuable complement to culture, in order to facilitate and expedite pathogen detection, thereby advancing efforts toward tailored precision medicine in the management of endophthalmitis.