Precision Metagenomic analysis of Urinary Track Infection (UTI)
Urinary tract infections (UTIs) remain a diagnostic challenge and often promote antibiotic overuse. Despite urine culture being the gold standard for UTI diagnosis, some uropathogens may lead to false negative or inconclusive results. Although PCR testing is fast and highly sensitive, its diagnostic yield is limited to targeted microorganisms. mNGS is a hypothesis-free approach with potential of deciphering the urobiome. However, clinically relevant information is often buried in the enormous amount of sequencing data.  Methods Precision metagenomics (PM) is a hybridization capture-based method with potential to enhanced discovery power and better diagnostic yield without diluting clinically relevant information. We collected 47 urine samples of clinically suspected UTI and in parallel tested each sample by microbial culture, PCR, and PM; then we comparatively analyzed the results. Next, we phenotypically classified the cumulative microbial population using the Explify? data analysis platform for potential pathogenicity.  Results Results revealed 100% positive predictive agreement (PPA) with culture results, which only identified 13 different microorganisms, compared to 19 and 62 organisms identified by PCR and PM, respectively. All identified organisms were classified into phenotypic groups (0 to 3) with increasing pathogenic potential and clinical relevance. This PM can simultaneously quantify and phenotypically classify the organisms readily through bioinformatic platforms like Explify?, essentially providing dissected and quantitative results for timely and accurate empiric UTI treatment.  Conclusion PM offers potential for building effective diagnostic models beyond usual care testing in complex UTI diseases. Future studies should assess the impact of PM-guided UTI management on clinical outcomes.