Detecting the Undectable

This week we chatted with Great Ormond Street Hospital who have been running a respiratory metagenomics service since November 2024.

Julianne Brown, Principal Clinical Scientist, shares her experience and top tips.

The GOSH team were no stranger to metagenomics, having delivered their own metagenomic service for infections in the central nervous system and sterile sites for over 10 years. That service, which uses short read sequencing, successfully tests both adult and paediatric cases from across the UK.

“We already knew the power of metagenomics, so we jumped at the chance to join the Respiratory Metagenomics Network. We were keen to bring the paediatric aspect into the network and combine our expertise together.”

Now in their second winter, the respiratory service operates 5 days a week and is fully embedded into both the clinical service and the laboratory systems.

“We’ve got dedicated staff working on the respiratory metagenomics and just like our other diagnostic services in the department, all our analysis and interpretation is done by biomedical scientists supported by Clinical Scientists and Consultant Microbiologists. We’ve also had great support from clinicians on the wards who are always willing to embrace new ideas. All these elements combined have been crucial for our success.”

When the service first started, they worked with a Clinical Fellow who worked hard to keep respiratory metagenomics in the spotlight. He proactively built relationships with the clinical teams and sent them daily headlines and results to ensure metagenomics was always front of their minds.

The team have recently had three exciting cases:

• Measles was found in a child with respiratory failure despite the child having no rash or distinct measles symptoms. With results being shared almost immediately, staff could implement infection control measures as well as managing the child’s treatment.
• A child with sepsis was found to have Group A Strep meaning they could get onto the correct treatment 24 hours before the PCR result arrived.
• Influenza C was detected in a patient who had respiratory failure meaning effective infection control could be put in place and the child could start the right treatment straight away. Influenza C wouldn’t have been picked up by a PCR panel.

“That’s the beauty of metagenomics; you can find the unexpected.”

When asked what advice she would give to new sites joining the network, Julianne said:

“Integrate metagenomics into your lab rather than see it as a separate project. This will enable you to speed up your whole service, remove unnecessary delays and engage staff across the department, from specimen reception through to reporting critical results.”