{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:15:35Z","timestamp":1788156935837,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"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. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Bronchoalveolar lavage fluid (BALF) is widely used for etiologic assessment of lower respiratory tract infection (LRTI), but its invasiveness limits routine use. This study evaluated induced sputum (IS) as a less-invasive specimen for targeted next-generation sequencing (tNGS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective exploratory study, paired IS and BALF samples from 30 adults with suspected LRTI underwent tNGS. The primary etiology was determined by composite clinical adjudication. Detected microorganisms were classified as definitive pathogens, conditional pathogens, or colonizers\/commensals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Clinical-match positivity was 70.0% (21\/30) for IS and 86.7% (26\/30) for BALF, while combining both specimens increased coverage to 93.3% (28\/30). Definitive pathogen detection was broadly similar between specimens, whereas colonizers\/commensals were more frequently detected in IS (45.6% vs 28.2%). After excluding six\n                      <jats:italic>Mycoplasma<\/jats:italic>\n                      \/\n                      <jats:italic>Mycobacterium<\/jats:italic>\n                      cases, clinical-match positivity was 75.0% for IS and 83.3% for BALF (McNemar exact\n                      <jats:italic>p<\/jats:italic>\n                      = 0.688).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Differences between IS and BALF tNGS were mainly attributable to upper-airway background signals. IS may serve as a less-invasive initial option in selected non-complex LRTIs, though further prospective validation in larger cohorts is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1845078","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:39:35Z","timestamp":1788154775000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Induced sputum versus bronchoalveolar lavage in lower respiratory tract infection: an exploratory paired diagnostic study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiaxi","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haimao","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dengfeng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yushu","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019.","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1038\/s41572-021-00259-0","article-title":"Pneumonia.","volume":"7","author":"Torres","year":"2021","journal-title":"Nat Rev Dis Primers"},{"key":"B3","doi-asserted-by":"publisher","first-page":"220150","DOI":"10.1183\/16000617.0150-2022","article-title":"Respiratory infections.","volume":"31","author":"Niederman","year":"2022","journal-title":"Eur Respir Rev"},{"key":"B4","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1146\/annurev-pathmechdis-012418-012751","article-title":"Clinical metagenomic next-generation sequencing for pathogen detection.","volume":"14","author":"Gu","year":"2019","journal-title":"Annu Rev Pathol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e24","DOI":"10.1128\/CMR.00024-17","article-title":"Syndromic panel-based testing in clinical microbiology.","volume":"31","author":"Ramanan","year":"2017","journal-title":"Clin Microbiol Rev"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e0052622","DOI":"10.1128\/jcm.00526-22","article-title":"Evaluation of metagenomic and targeted next-generation sequencing workflows for detection of respiratory pathogens from bronchoalveolar lavage fluid specimens.","volume":"60","author":"Gaston","year":"2022","journal-title":"J Clin Microbiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1578939","DOI":"10.3389\/fcimb.2025.1578939","article-title":"Comparison of the diagnostic capabilities of tNGS and mNGS for pathogens causing lower respiratory tract infections: a prospective observational study.","volume":"15","author":"Ding","year":"2025","journal-title":"Front Cell Infect Microbiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"105307","DOI":"10.1016\/j.ebiom.2024.105307","article-title":"Enhancing lower respiratory tract infection diagnosis: implementation and clinical assessment of multiplex PCR-based and hybrid capture-based targeted next-generation sequencing.","volume":"107","author":"Yin","year":"2024","journal-title":"EBioMedicine"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia. 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