“Great Ormond Street Hospital (GOSH) has successfully implemented a pioneering same-day respiratory metagenomics testing service for children in intensive care, helping clinicians identify infections more quickly and make better-informed treatment decisions. The findings, published today in The Lancet Microbe, mark the first implementation of a same-day pan-microbial metagenomics service for children…
The service, developed from a pathway first established at Guy's and St Thomas' NHS Foundation Trust, was implemented at GOSH during the 2024-25 winter season. The team analysed 177 respiratory samples from 122 critically ill children and found that the technology could rapidly detect bacteria, viruses and fungi with high accuracy, while identifying infections that routine testing had missed.
Metagenomics works by sequencing all genetic material within a sample, enabling clinicians to search broadly for potential infectious causes rather than testing for a limited number of suspected pathogens. Unlike conventional diagnostic approaches, clinicians do not need to decide in advance what they are looking for.
The study found that metagenomics delivered results that altered clinical management in almost one-third (29%) of samples tested. In a quarter of cases (26%), the results influenced antimicrobial prescribing, including starting, stopping or changing antibiotics, or providing confidence that the current treatment was appropriate.
Importantly, the service detected 50 organisms that were not identified by routine diagnostic tests, all of which were subsequently confirmed by additional testing.”
