Objective:

To evaluate the impact of metagenomic next-generation sequencing (mNGS) on the diagnostic pathways and resource allocation for central nervous system infections and autoimmune encephalitis, with a focus on improving diagnostic accuracy and efficiency.

Key Findings:

• Utilizing mNGS could reduce the number of microbiological tests by up to 88 for DNA viral infections and 30 for bacterial infections, with statistical significance.
• Estimated reduction in time to diagnosis could be 145 days for DNA viral infections and 144 days for bacterial infections, highlighting the efficiency of mNGS.
• In the autoimmune cohort, mNGS could have avoided 126 microbiological tests and 297 days to diagnosis, indicating substantial resource savings.

Interpretation:

mNGS has the potential to significantly streamline diagnostic and treatment pathways for CNS infections, thereby reducing unnecessary procedures and time to diagnosis, which could lead to better patient outcomes.

Limitations:

• High cost and variable turnaround times of mNGS may limit its immediate implementation in clinical settings, affecting accessibility.
• Absence of established clinical guidelines for mNGS use in real-world settings poses challenges for widespread adoption.

Conclusion:

The study suggests that mNGS could enhance diagnostic efficiency for CNS infections, warranting further exploration and validation in clinical practice to establish guidelines and optimize resource allocation.