A pioneering same-day metagenomic test has been used to detect hidden and drug-resistant infections in critically ill children at London's Great Ormond Street Hospital (GOSH). Respiratory samples from over 100 young patients in intensive care were analysed using this method.
Metagenomic testing can identify bacteria, viruses, and fungi from a single sample, often influencing doctors' prescribing decisions. This approach can detect infections that standard tests might miss, potentially leading to better outcomes for some patients.
During a study conducted in 2024-5, metagenomic testing was applied to 122 critically ill children in the paediatric intensive care unit at GOSH. The results, published in The Lancet Microbe, showed that the test identified around nine in 10 bacteria and viruses, and all fungi in samples. In a quarter of cases, the findings led to changes in antibiotic treatment, including starting, stopping, or altering prescriptions.
Dr Sam Ray, a consultant in paediatric intensive care medicine at GOSH and co-author of the study, noted that traditional testing often requires clinicians to make an educated guess about the infection. He stated that the study helped to identify missed infections, guide appropriate treatment, and discontinue ineffective antibiotics, which is important for combating antimicrobial resistance.
The testing at GOSH also identified 50 organisms not detected by routine diagnostics, suggesting its potential role as an early warning system for new infections. Dr Julianne Brown, head of the GOSH Metagenomics Service and co-senior author, indicated that the new testing is being gradually introduced to about 30 intensive care units across the UK, treating both adults and children.