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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AbstractBackground: Metagenomic next-generation sequencing of microbial cell-free DNA (mcfDNA) allows for noninvasive 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. Key Points This is a retrospective study evaluating the clinical impact of mcfDNA testing at a single center. mcfDNA positively impacted clinical care in 43% of cases. Patients admitted with sepsis, patients receiving antibiotics for less than 7 days, and solid organ transplant recipients derived the most benefit from mcfDNA testing.
DescriptionThe article processing charges (APC) for this open access article were partially funded by the Health Sciences and Human Services Library's Open Access Publishing Fund for Early-Career Researchers.
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Identifier to cite or link to this itemhttp://hdl.handle.net/10713/20992
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Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivatives 4.0 International