Clinical application of cell-free next-generation sequencing for infectious diseases at a tertiary children’s hospital

• DOI: 10.1186/s12879-021-06292-4
• Publication Date: 2021-06-11T01:02:51Z
• Authors: Julianne Wilke; Nanda Ramchandar; Christopher Canna...; Alice Pong; Adriana Tremoulet; Leidy Tovar Padua; Helen Harvey; Jennifer Foley; Lauge Farnaes; Nicole G. Coufal
• Keywords: Male; 0301 basic medicine; Adolescent; Clinical Sciences; 610; Clinical sciences; Infectious and parasitic diseases; RC109-216; Microbiology; Communicable Diseases; 618; 03 medical and health sciences; Diagnostic Tests; Clinical Research; Humans; Routine; Preschool; Child; Children; Retrospective Studies; Pediatric; screening and diagnosis; Public health; Cell-free plasma; Biomedical and Clinical Sciences; Diagnostic Tests, Routine; Research; High-Throughput Nucleotide Sequencing; Medical microbiology; Hospitals, Pediatric; Hospitals; 4.1 Discovery and preclinical testing of markers and technologies; 3. Good health; Detection; Infectious Diseases; Good Health and Well Being; Medical Microbiology; Child, Preschool; Next-generation sequencing; Metagenome; Female; Metagenomics; Infection; Cell-Free Nucleic Acids; 4.2 Evaluation of markers and technologies

Abstract Background Children affected by infectious diseases may not always have a detectable infectious etiology. Diagnostic uncertainty can lead to prolonged hospitalizations, inappropriately broad or extended courses of antibiotics, invasive diagnostic procedures, and difficulty predicting the clinical course and outcome. Cell-free plasma next-generation sequencing (cfNGS) can identify viral, bacterial, and fungal infections by detecting pathogen DNA in peripheral blood. This testing modality offers the ability to test for many organisms at once in a shotgun metagenomic approach with a rapid turnaround time. We sought to compare the results of cfNGS to conventional diagnostic test results and describe the impact of cfNGS on clinical care in a diverse pediatric population at a large academic children’s hospital.

Methods We performed a retrospective chart review of hospitalized subjects at a tertiary pediatric hospital to determine the diagnostic yield of cfNGS and its impact on clinical care.

Results We describe the clinical application of results from 142 cfNGS tests in the management of 110 subjects over an 8-month study period. In comparison to conventional testing as a reference standard, cfNGS was found to have a positive percent agreement of 89.6% and negative percent agreement of 52.3%. Furthermore, 32.4% of cfNGS results were directly applied to make a clinical change in management.

Conclusions We demonstrate the clinically utility of cfNGS in the management of acutely ill children. Future studies, both retrospective and prospective, are needed to clarify the optimal indications for testing.