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    Clinical impact of a metagenomic microbial plasma cell-free DNA next-generation sequencing assay on treatment decisions: a single-center retrospective study.

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    Author
    Shishido, Akira A
    Noe, Myint
    Saharia, Kapil
    Luethy, Paul
    Date
    2022-04-13
    Journal
    BMC Infectious Diseases
    Publisher
    Springer Nature
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1186/s12879-022-07357-8
    Abstract
    BACKGROUND: Metagenomic next-generation sequencing of microbial cell-free DNA (mcfDNA) allows for non-invasive pathogen detection from plasma. However, there is little data describing the optimal role for this assay in real-world clinical decision making. METHODS: We performed a single-center retrospective cohort study of adult patients for whom a mcfDNA (Karius©) test was sent between May 2019 and February 2021. Clinical impact was arbitrated after review and discussion of each case. RESULTS: A total of 80 patients were included. The most common reason for sending the assay was unknown microbiologic diagnosis (78%), followed by avoiding invasive procedures (14%). The test had a positive impact in 34 (43%), a negative impact in 2 (3%), and uncertain or no impact in 44 (55%). A positive impact was observed in solid organ transplant recipients (SOTR, 71.4%, p = 0.003), sepsis (71.4%, p = 0.003), and those receiving antimicrobial agents for less than 7 days prior to mcfDNA testing (i.e., 61.8%, p = 0.004). Positive impact was driven primarily by de-escalation of antimicrobial therapy. CONCLUSION: Clinical impact of mcfDNA testing was highest in SOTR, patients with sepsis and patients who had been on antimicrobial therapy for less than 7 days. Positive impact was driven by de-escalation of antimicrobial therapy which may highlight a potential role for mcfDNA in the realm of stewardship.
    Rights/Terms
    © 2022. The Author(s).
    Keyword
    Cell-free DNA
    Karius©
    Next-generation sequencing
    Sepsis
    Transplant infectious disease
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/18603
    ae974a485f413a2113503eed53cd6c53
    10.1186/s12879-022-07357-8
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