Background: Acute exacerbation of bronchiectasis (AEB) is a fatal disease in the respiratory system. Herein, we aimed to compare the detection efficacy of metagenomic next-generation sequencing (mNGS) and standard methods between high-risk and low-risk AEB patients.

Methods: Retrospectively, medical data of AEB patients (n = 52) were collected between March 2022 and January 2023. Based on the number of acute exacerbations in the previous year and hospitalization history, patients were categorized into a high-risk group and a low-risk group. According to the study's inclusion and exclusion criteria, a total of 52 AEB patients were included (28 high-risk and 24 low-risk). Baseline clinical data were analyzed, and mNGS of bronchoalveolar lavage fluid (BALF) samples was performed.

Results: Significant differences were observed between the high-risk and low-risk groups in disease duration, number of clinical visits, number of admissions, white blood cell count, neutrophil percentage, high-sensitivity C-reactive protein (hs-CRP), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) levels (p < 0.05). mNGS demonstrated clear advantages in detecting pathogens in BALF samples from patients with bronchiectasis, offering higher sensitivity and broader pathogen spectrum coverage. mNGS can effectively complement the limitations of conventional culture methods. The mNGS results showed that the infection rates of Pseudomonas aeruginosa and Klebsiella pneumoniae were higher in the high-risk group compared to the low-risk group (p < 0.05).

Conclusion: The mNGS proves to be an effective tool in assessing the respiratory microbiota and has the potential to improve the diagnosis and treatment of AEB patients by enabling rapid and precise pathogen detection.