Université de Paris, IAME, INSERM, 75018, Paris, France.
AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France.
Drugs. 2021 Sep;81(13):1453-1466. doi: 10.1007/s40265-021-01572-4. Epub 2021 Jul 30.
Clinical metagenomics (CMg) is the process of sequencing nucleic acid of clinical samples to obtain clinically relevant information such as the identification of microorganisms and their susceptibility to antimicrobials. Over the last decades, sequencing and bioinformatic solutions supporting CMg have much evolved and an increasing number of case reports and series covering various infectious diseases have been published. Metagenomics is a new approach to infectious disease diagnosis that is currently being developed and is certainly one of the most promising for the coming years. However, most CMg studies are retrospective, and few address the potential impact CMg could have on patient management, including initiation, adaptation, or cessation of antimicrobials. In this narrative review, we have discussed the potential role of CMg in bacteriology, virology, mycology, and parasitology. Several reports and case-series confirm that CMg is an innovative tool with which one can (i) identify more microorganisms than with conventional methods in a single test, (ii) obtain results within hours, and (iii) tailor the antimicrobial regimen of patients. However, the cost-efficiency of CMg and its real impact on patient management are still to be determined.
临床宏基因组学（CMg）是对临床样本的核酸进行测序以获得临床相关信息的过程，例如鉴定微生物及其对抗生素的敏感性。在过去的几十年中，支持 CMg 的测序和生物信息学解决方案有了很大的发展，越来越多的涵盖各种传染病的病例报告和系列已经发表。宏基因组学是一种新的传染病诊断方法，目前正在开发中，无疑是未来几年最有前途的方法之一。然而，大多数 CMg 研究都是回顾性的，很少有研究探讨 CMg 对患者管理（包括开始、适应或停止使用抗生素）可能产生的潜在影响。在这篇叙述性综述中，我们讨论了 CMg 在细菌学、病毒学、真菌学和寄生虫学中的潜在作用。一些报告和病例系列证实，CMg 是一种创新工具，它可以（i）在单次检测中比常规方法识别更多的微生物，（ii）在数小时内获得结果，以及（iii）为患者定制抗生素治疗方案。然而，CMg 的成本效益及其对患者管理的实际影响仍有待确定。
