218: Metagenomics in Clinical Microbiology

In this episode of Let's Talk Micro, we break down metagenomic next-generation sequencing (mNGS) and how it's changing the way we diagnose complex infectious diseases.

I'm joined by Steve Miller, MD, PhD—Chief Medical Officer at Delve Bio—to discuss how unbiased metagenomics moved from research labs into real-world clinical practice.

We cover what metagenomics is, how it differs from targeted PCR and sequencing, and where it adds the most value—especially in meningitis and encephalitis, immunocompromised patients, and cases where routine testing comes back negative.

Dr. Miller shares insights from years of clinical experience, including how mNGS can improve diagnostic yield, shorten time to diagnosis, guide targeted therapy, and reduce unnecessary testing and hospital stays. We also touch on challenges like cost, result interpretation, diagnostic stewardship, and where metagenomics is headed next—including its role in public health and emerging infections.

Links & Resources

• Clinical metagenomics for meningitis and encephalitis (Nature Medicine)
  https://www.nature.com/articles/s41591-024-03275-1

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