早期有效、准确的抗生素治疗是降低重症感染患者病死率的关键，准确鉴别病原微生物是恰当的抗生素治疗最重要的前提条件。宏基因组学二代测序技术（mNGS）是一种新型的病原学诊断技术，其具有检测速度快、准确率高、覆盖广泛等特点，近年来已被用于某些特殊病原微生物感染的诊断中。然而，该技术在重症感染早期抗感染目标性治疗中仍存在诸多问题亟待解决。本文总结mNGS在重症领域使用过程中依然面临的几个需要思考的问题。

Early effective and accurate antibiotic therapy is the key to reduce mortality of patients with severe infections. Identification of pathogenic microorganism is essential for appropriate antibiotic therapy. Metagenomics next generation sequencing (mNGS) is a novel pathogenic, diagnostic technology with fast detection speed, high accuracy, and comprehensive coverage. mNGS has been used to diagnose specific pathogenic microbial infections in recent years. However, many problems still need to be solved in the early target anti-microbial therapy of severe infections. This paper summarizes several problems that need to be considered in the use of mNGS in severe cases.