{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:15:33Z","timestamp":1778220933185,"version":"3.51.4"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Complicated urinary tract infections (cUTIs) represent a critical subset of pediatric UTIs, characterized by diverse complex factors stemming from the patient, disease status, and pathogen-related attributes. Without timely and precise management, cUTIs may progress to invasive renal parenchymal infection (IRPI), posing long\u2212term health risks. A central challenge in cUTI management lies in the limitations of urine culture, including prolonged turnaround time and suboptimal sensitivity, particularly post-antibiotic exposure. Hybrid Capture-Based targeted next-generation sequencing (hc-tNGS), a culture-independent emerging etiological assay, provides a potential solution to optimize clinical care. However, evidence regarding its utility in pediatric cUTI cohorts remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2212center, retrospective study enrolled 88 pediatric cUTI patients. All participants underwent sequential urine culture followed by hc\u2212tNGS. The performance of the two methods in terms of pathogen spectrum, detection rate, and potential implications for antibiotic therapy optimization were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Hc\u2212tNGS demonstrated significantly higher pathogen detection sensitivity compared to conventional urine culture (92.5% vs. 33.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). Meanwhile, hc\u2212tNGS uniquely identified polymicrobial bacterium-bacterium or bacterial-fungal infections in 58% cases, a profile missed by culture. Furthermore,\n                      <jats:italic>Klebsiella<\/jats:italic>\n                      species infection was identified as an independent risk factor for IRPI. Pathogen genetic profiling revealed that virulence and resistance genes were primarily clustered within\n                      <jats:italic>E. coli<\/jats:italic>\n                      -associated monomicrobial or polymicrobial pathogens, mainly including adhesion\u2212related\n                      <jats:italic>ompA<\/jats:italic>\n                      , siderophore genes (\n                      <jats:italic>iucA\/B\/C<\/jats:italic>\n                      ), and CTX\u2212M resistance genotypes, respectively. In the vesicoureteral reflux (VUR) subgroup, this comprehensive profiling was associated with antibiotic adjustments in 71% cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sequential hc\u2212tNGS provides a clinical diagnostic approach for cUTI as a complement to urine culture, especially after prior antibiotic use or suspected renal involvement. It enables accurate detection of polymicrobial and difficult\u2212to\u2212culture pathogens. These findings suggest that hc\u2212tNGS may be integrated into routine diagnostic workflows to help guide targeted therapy and improve patient management in complex UTI settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1826277","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:52:11Z","timestamp":1778219531000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of hc-tNGS for pathogen identification for pediatric cUTIs: a real-world observational study"],"prefix":"10.3389","volume":"16","author":[{"given":"Lin","family":"Huang","sequence":"first","affiliation":[{"name":"Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juanjuan","family":"Ding","sequence":"additional","affiliation":[{"name":"Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baolong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Institute for Systems Biology, School of Life Sciences, Jianghan University","place":["Wuhan, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Sun","sequence":"additional","affiliation":[{"name":"Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Chen","sequence":"additional","affiliation":[{"name":"Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Na","family":"Li","sequence":"additional","affiliation":[{"name":"Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxia","family":"Peng","sequence":"additional","affiliation":[{"name":"Beijing Children\u2019s Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huihui","family":"Yang","sequence":"additional","affiliation":[{"name":"Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowen","family":"Wang","sequence":"additional","affiliation":[{"name":"Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1038\/s41585-021-00477-x","article-title":"Molecular determinants of disease severity in urinary tract infection","volume":"18","author":"Ambite","year":"2021","journal-title":"Nat. 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