Metagenomic next-generation sequencing (mNGS) is increasingly being applied in clinical laboratories for unbiased culture-independent diagnosis. Whether it can be a next routine pathogen identification tool has become a topic of concern. We review the current implementation of this new technology for infectious disease diagnostics and discuss the feasibility of transforming mNGS into a routine diagnostic test. Since 2008, numerous studies from over 20 countries have revealed the practicality of mNGS in the work-up of undiagnosed infectious diseases. mNGS performs well in identifying rare, novel, difficult-to-detect and coinfected pathogens directly from clinical samples and presents great potential in resistance prediction by sequencing the antibiotic resistance genes, providing new diagnostic evidence that can be used to guide treatment options and improve antibiotic stewardship. Many physicians recognized mNGS as a last resort method to address clinical infection problems. Although several hurdles, such as workflow validation, quality control, method standardisation, and data interpretation, remain before mNGS can be implemented routinely in clinical laboratories, they are temporary and can be overcome by rapidly evolving technologies. With more validated workflows, lower cost and turnaround time, and simplified interpretation criteria, mNGS will be widely accepted in clinical practice. Overall, mNGS is transforming the landscape of clinical microbiology laboratories, and to ensure that it is properly utilised in clinical diagnosis, both physicians and microbiologists should have a thorough understanding of the power and limitations of this method.

元基因组下一代测序（mNGS）越来越多地用于临床实验室，用于无偏倚的培养独立诊断。它是否可以成为下一个常规病原体鉴定工具已经成为人们关注的话题。我们回顾了这种新技术在传染病诊断中的当前应用，并讨论了将mNGS转换为常规诊断测试的可行性。自2008年以来，来自20多个国家的大量研究表明，mNGS在诊断未诊断的传染病方面具有实用性。mNGS在直接从临床样品中鉴定罕见，新颖，难以检测和共感染的病原体方面表现良好，并且通过对抗生素抗性基因进行测序，在抗性预测中具有巨大潜力，提供新的诊断证据，可用于指导治疗方案和改善抗生素管理。许多医生认为mNGS是解决临床感染问题的不得已的方法。尽管在临床实验室中常规实施mNGS之前，仍存在一些障碍，例如工作流程验证，质量控制，方法标准化和数据解释，但这些障碍是暂时的，可以通过快速发展的技术来克服。随着更多经过验证的工作流程，更低的成本和周转时间以及简化的解释标准，mNGS将在临床实践中被广泛接受。总体而言，mNGS正在改变临床微生物学实验室的格局，并确保将其正确用于临床诊断，