Microbial Cell-Free DNA Identifies Etiology of Bloodstream Infections, Persists Longer Than Conventional Blood Cultures, and Its Duration of Detection Is Associated With Metastatic Infection in Patients With Staphylococcus aureus and Gram-Negative Bacteremia.

Autor:	Eichenberger EM; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA., de Vries CR; Karius Inc, Redwood City, California, USA., Ruffin F; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA., Sharma-Kuinkel B; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA., Park L; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA., Hong D; Karius Inc, Redwood City, California, USA., Scott ER; Karius Inc, Redwood City, California, USA., Blair L; Karius Inc, Redwood City, California, USA., Degner N; Karius Inc, Redwood City, California, USA., Hollemon DH; Karius Inc, Redwood City, California, USA., Blauwkamp TA; Karius Inc, Redwood City, California, USA., Ho C; Karius Inc, Redwood City, California, USA., Seng H; Karius Inc, Redwood City, California, USA., Shah P; Department of Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA., Wanda L; Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.; Department of Medicine, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA., Fowler VG; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA., Ahmed AA; Karius Inc, Redwood City, California, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2022 Jun 10; Vol. 74 (11), pp. 2020-2027.
DOI:	10.1093/cid/ciab742
Abstrakt:	Background: Microbial cell-free DNA (mcfDNA) sequencing of plasma can identify the presence of a pathogen in a host. In this study, we evaluated the duration of pathogen detection by mcfDNA sequencing vs conventional blood culture in patients with bacteremia. Methods: Blood samples from patients with culture-confirmed bloodstream infection were collected within 24 hours of the index positive blood culture and 48 to 72 hours thereafter. mcfDNA was extracted from plasma, and next-generation sequencing was applied. Reads were aligned against a curated pathogen database. Statistical significance was defined with Bonferroni adjustment for multiple comparisons (P < .0033). Results: A total of 175 patients with Staphylococcus aureus bacteremia (n = 66), gram-negative bacteremia (n = 74), or noninfected controls (n = 35) were enrolled. The overall sensitivity of mcfDNA sequencing compared with index blood culture was 89.3% (125 of 140), and the specificity was 74.3%. Among patients with bacteremia, pathogen-specific mcfDNA remained detectable for significantly longer than conventional blood cultures (median 15 days vs 2 days; P < .0001). Each additional day of mcfDNA detection significantly increased the odds of metastatic infection (odds ratio, 2.89; 95% confidence interval, 1.53-5.46; P = .0011). Conclusions: Pathogen mcfDNA identified the bacterial etiology of bloodstream infection for a significantly longer interval than conventional cultures, and its duration of detection was associated with increased risk for metastatic infection. mcfDNA could play a role in the diagnosis of partially treated endovascular infections. (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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