Objective To explore the value of Metagenomic Next-generation Sequencing (mNGS) in the detection of pathogens in sterile sites of patients with suspected infectious diseases. Methods A total of 672 patients with suspected infectious diseases by bacterial culture and mNGS admitted to The Fifth Affiliated Hospital of Sun Yat-sen University from January 2018 to November 2019 were retrospectively analyzed. The positive rate and influencing factors (antibiotic exposure, specimen type), pathogen distribution, department distribution. Results The culture positive rate was 8.6%, metagenomic sequencing was 35.4%, and bacterial, viral, fungal, rickettsial, parasitic and Mycoplasma / chlamydia were detected in 43.7%, 21.9%, 15.4%, 16.1%, 1.8% and 1.1% of samples with metagenomic sequencing positive from 672 patients, respectively; the positive rates before and after antibiotic use were 32.9% and 37.9%, respectively (P>0.05). The constituent ratios of blood, cerebrospinal fluid, tissue, joint puncture fluid and other specimens the positive detection rates were 40.5%, 24.1%, 45.0%, 36.8% and 30.4%, respectively (P<0.05). Infection department hematology, neurology, orthopedics, respiratory medicine, ICU and other departments, respectively, and the positive detection rates were 42.9%, 34.2%, 15.7%, 36.7%,28.6%, 21.1% and 39.0%, respectively (P<0.05). Consistency analysis of mNGS and culture: 41 out of 672 patients were positive for mNGS and culture, of which 31 were consistent with mNGS and 10 were inconsistent with mNGS; among 434 samples with negative mNGS, 17 were culture positive. Conclusion Metagenomic Next-generation Sequencing improves the detection rate of infectious diseases pathogens, especially for viruses, Rickettsia, parasites, Mycobacterium tuberculosis and rare pathogens, but the detection results of Metagenomic Next-generation Sequencing should be combined with epidemiological and clinical characteristics to comprehensively evaluate whether it is a pathogen. Antibiotics had little effect on the positive rate of mNGS. [ABSTRACT FROM AUTHOR]