Cerebrospinal fluid (CSF) metagenomic next generation sequencing (mNGS) can detect diverse pathogens in patients with central nervous system infection. Due to its high cost and unclear clinical utility, it is typically reserved for patients with unrevealing routine workups. A multi-center retrospective analysis of real-world CSF mNGS was performed involving orders between 2017 and 2022 at a large New England healthcare system. CSF mNGS was performed 64 times with 17 positive results (27 %). In 11/17 positive samples (65 %), the infectious agent had not been previously detected using routine methods. Arboviruses (n = 8) were the most frequently detected agents, particularly Powassan virus (n = 6). Results changed therapy in 3/64 cases (5 %). Positive results were associated with immunodeficiency (p = 0.06), especially anti-B-cell therapy (p = 0.02), and earlier sample collection (p = 0.06). The association with compromised humoral immunity was stronger in the arbovirus and Powassan virus subgroups (p = 0.001), whose constituents were older than the overall cohort and had higher mortality rates.

脑脊液（CSF）宏基因组下一代测序（mNGS）可以检测中枢神经系统感染患者的多种病原体。由于其成本高且临床效用不明确，它通常保留给常规检查不明确的患者。对真实世界的 CSF mNGS 进行了多中心回顾性分析，涉及新英格兰大型医疗保健系统 2017 年至 2022 年间的订单。CSF mNGS 进行了 64 次，有 17 次阳性结果 (27%)。在 11/17 的阳性样本 (65%) 中，以前未使用常规方法检测到传染原。虫媒病毒 ( n  = 8) 是最常检测到的病原体，特别是波瓦桑病毒 ( n  = 6)。结果 3/64 例 (5%) 改变了治疗。阳性结果与免疫缺陷 ( p  = 0.06)，尤其是抗 B 细胞治疗 ( p  = 0.02) 以及早期样本采集 ( p = 0.06)相关 。在虫媒病毒和波瓦桑病毒亚组中，与体液免疫受损的相关性更强（p  = 0.001），这些亚组的组成成分比整体人群年龄更大，死亡率更高。