Metagenomic next-generation sequencing in blood culture-negative endocarditis: a structured review with illustrative pooled estimates.
Metagenomic sequencing detects pathogens in 92% of infected heart valve tissue.
Metagenomic next-generation sequencing in blood culture-negative endocarditis: a structured review with illustrative pooled estimates.
Infective endocarditis is a life-threatening cardiovascular infection with high morbidity and mortality.
This is a structured literature review with illustrative pooled estimates retrieved from PubMed and Google Scholar using searches for infective endocarditis including BCNE cases and sequencing methods.
sequencing identified the pathogen in nearly all infected valve samples
The database searches identified 12 clinical studies with 794 patients, 10 prospective and two retrospective studies; no randomised controlled trials.
Relative diagnostic yield, based on ratios of pooled proportions, showed a 2-fold lower yield for blood culture vs. mNGS and a 4-fold lower yield for valve tissue culture vs. mNGS.
mNGS is increasingly being implemented in routine infective endocarditis diagnostics and has consistently demonstrated high diagnostic yield across heterogeneous studies, particularly in valve tissue compared with blood and valve tissue culture.
Consensus on diagnostic algorithms, standardised mNGS testing, and randomised controlled trials are needed to further define the role of mNGS in BCNE.