ReviewInfection2026
Metagenomic next-generation sequencing in blood culture-negative endocarditis: a structured review with illustrative pooled estimates.
Review in Infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
1 author.
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Abstract
backgroundInfective endocarditis is a life-threatening cardiovascular infection with high morbidity and mortality. Identification of the causative microbial pathogen is essential for targeted antimicrobial treatment. Blood culture-negative endocarditis accounts for up to 30% of the cases and supplementary diagnostics (antigen, serology, histopathology, PCR, 16 S/18S) are unable to detect all pathogens. Recent sequencing-based diagnostics, including metagenomic next-generation sequencing (mNGS), have been incorporated as adjunctive tools in the 2023 Duke-ISCVID criteria.
methodsThis 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.
resultsThe database searches identified 12 clinical studies with 794 patients, 10 prospective and two retrospective studies; no randomised controlled trials. Illustrative pooled estimates were calculated using random-effects meta-analyses of proportions and presented in forest plots; mNGS microbial diagnostic yield 0.87 (0.83-0.89), mNGS valve tissue pooled diagnostic yield 0.92 (0.80-0.97), blood culture diagnostic yield 0.43 (0.28-0.58) and valve tissue diagnostic yield 0.23 (0.12-0.39). 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.
conclusionmNGS 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.