Effect of tNGS on CAP Patients With Initial Treatment Failure

Inclusion Criteria: * Adults (age ≥ 18 years) * Diagnosed of community-acquired pneumonia * Initial treatment failure Exclusion Criteria: * tNGS or mNGS already performed on respiratory samples during the current illness * Suspected lung abscess or empyema * Cerebral infarction within the past three months * Dysphagia * Nasopharyngeal carcinoma currently receiving radiotherapy * Tracheostomy * Long-term bedridden patients (ADL score ≤ 60) * Pathogens identified within the past 7 days that adequately explain the current clinical presentation * Bronchiectasis with large amounts of sputum and documented bacterial detection within the past six months * Inability to obtain eligible respiratory samples * CURB-65 score ≤ 1 * Expected discharge or death within 48 hours