Table 3.

Evaluation of a Metagenomic Assay for Detection of CSF Pathogens Against a Composite Reference of Usual Care Testing^a

CSF mNGS % Positivity	28.6%
CSF mNGS positive predictive agreement	80.0 (95%, 59.3–93.2%)
CSF mNGS negative predictive agreement	91.1 (95%, 78.8–97.5%)
% agreement (kappa)	87.1 (0.80)

Abbreviations: CSF, cerebrospinal fluid; mNGS, metagenomic next-generation sequencing.

^aEach mNGS result was identified as a true positive, false positive, true negative, or false negative relative to usual care testing from CSF (composite of polymerase chain reaction [PCR], culture, and serologic testing for each subject) as the reference standard. A culture was sent for every subject. Dedicated enterovirus PCR was sent for 19 subjects, and dedicated herpes simplex virus PCR was sent for 13 subjects. A multiplex PCR was sent for 52 subjects. A dedicated Epstein-Barr virus PCR was sent for 1 subject. Broad-range universal PCR was sent for 1 subject.