Despite promising results, metagenomics remains underutilized in the ICU. Several factors still limit its inclusion in routine critical care, including the lack of definitive clinical trials testing its utility, few laboratories with the infrastructure needed to afford rapid turnaround, cost in low resource settings, and the fact that few metagenomics assays have undergone the clinical validation needed to permit use in patient care.

These barriers will need to be overcome before wide adoption of metagenomics into clinical practice.

However, an increasing number of studies are demonstrating the potential utility of metagenomics in a range of settings relevant to critically ill patients.

Moving forward, a gradual inclusion of metagenomics into current clinical diagnosis pipelines, starting from a complementary inclusion along with currently used tests in severely ill patients, may demonstrate the full potential of this technology in the ICU.

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