Hostname: page-component-669899f699-7tmb6 Total loading time: 0 Render date: 2025-05-05T05:15:44.565Z Has data issue: false hasContentIssue false
  • English
  • Français

Incorporating microbial cell-free DNA testing into healthcare-associated invasive fungal infection surveillance: benefits and challenges

Published online by Cambridge University Press:  04 April 2025

Daniel Z. Uslan Open the ORCID record for Daniel Z. Uslan [Opens in a new window] ,
Ishminder Kaur Open the ORCID record for Ishminder Kaur [Opens in a new window] ,
Omai B. Garner Open the ORCID record for Omai B. Garner [Opens in a new window]  and
Shangxin Yang
Daniel Z. Uslan*
Affiliation:
Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Clinical Epidemiology & Infection Prevention, UCLA Health, Los Angeles, CA, USA
Ishminder Kaur
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Omai B. Garner
Affiliation:
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Shangxin Yang
Affiliation:
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
*
Corresponding author: Daniel Z. Uslan; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Surveillance by clinical epidemiology teams for invasive fungal infections (IFIs) in healthcare settings can be challenging due to several factors including low sensitivity of noninvasive conventional microbiologic diagnostics, nonspecific clinical presentation, and complex patient populations. Recently, availability of microbial cell-free DNA testing (cfDNA) via the Karius Test has shown promise for increased diagnostic sensitivity of IFIs. However, how to best incorporate cfDNA results into IFI surveillance remains a vexing challenge. Herein, we provide perspectives on the benefits and challenges of use of cfDNA for IFI surveillance.

Keywords

Karius testmicrobial cell-free DNAsurveillancefungal diagnostics
Type
Commentary
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 5 , May 2025 , pp. 445 - 448
Check for updates
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

WHO fungal priority pathogens list to guide research, development and public health action. Accessed November 20, 2024. https://www.who.int/publications/i/item/9789240060241 Google Scholar
Glowicz, J, Benowitz, I, Arduino, MJ, et al. Keeping health care linens clean: Underrecognized hazards and critical control points to avoid contamination of laundered health care textiles. Am J Infect Control. 2024;50:1178–1181. doi: 10.1016/j.ajic.2022.06.026 CrossRefGoogle Scholar
Guidance for Healthcare-Associated Mold Outbreaks | Fungal Diseases | CDC. Accessed November 20, 2024. https://www.cdc.gov/fungal/php/guidance-investigating-outbreaks/mold-healthcare.html Google Scholar
Douglas, AP, Stewart, AG, Halliday, CL, Chen, SCA. Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management. Journal of Fungi. 2023;9:1059. doi: 10.3390/JOF9111059 CrossRefGoogle ScholarPubMed
Hartnett, KP, Jackson, BR, Perkins, KM, et al. A Guide to Investigating Suspected Outbreaks of Mucormycosis in Healthcare. Journal of Fungi 2019, Vol 5, Page 69. 2019;5:69. doi: 10.3390/JOF5030069 Google ScholarPubMed
Kanamori, H, Rutala, WA, Sickbert-Bennett, EE, Weber, DJ. Review of Fungal Outbreaks and Infection Prevention in Healthcare Settings During Construction and Renovation. Clin Infect Dis. 2015;61:433–444. doi: 10.1093/CID/CIV297 CrossRefGoogle ScholarPubMed
Peter Donnelly, J, Chen, SC, Kauffman, CA, et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020;71:1367–1376. doi: 10.1093/CID/CIZ1008 CrossRefGoogle Scholar
Targeted Environmental Investigation Checklist for Outbreaks of Invasive Infections Caused by Environmental Fungi. Accessed November 24, 2024. https://www.cdc.gov/fungal/pdf/targeted-environmental-investigation-checklist-508.pdf Google Scholar
Huygens, S, Schauwvlieghe, A, Wlazlo, N, et al. Diagnostic Value of Microbial Cell-free DNA Sequencing for Suspected Invasive Fungal Infections: A Retrospective Multicenter Cohort Study. Open Forum Infect Dis. 2024;11:1–10. doi: 10.1093/OFID/OFAE252 CrossRefGoogle ScholarPubMed
Lestrade, PP, Bentvelsen, RG, Schauwvlieghe, AFAD, et al. Voriconazole resistance and mortality in invasive Aspergillosis: a multicenter retrospective cohort study. Clin Infect Dis. 2019;68:1463–1471. doi: 10.1093/CID/CIY859 CrossRefGoogle ScholarPubMed
Patterson, JE, Zidouh, A, Miniter, P, Andriole, VT, Patterson, TF. Hospital epidemiologic surveillance for invasive aspergillosis: patient demographics and the utility of antigen detection. Infect Control Hosp Epidemiol. 1997;18:104–108. doi: 10.1086/647563 CrossRefGoogle ScholarPubMed
Patterson, TF, Thompson, GR, Denning, DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63:e1–e60. doi: 10.1093/CID/CIW326 CrossRefGoogle ScholarPubMed
Patwari, P, Cutrell, J, Bhaskaran, A, Trevino, S, Sreeramoju, P. Surveillance of patients identified with fungal mold at a public academic medical center. Am J Infect Control. 2014;42:776–780. doi: 10.1016/j.ajic.2014.03.025 CrossRefGoogle Scholar
Hong, DK, Blauwkamp, TA, Kertesz, M, Bercovici, S, Truong, C, Banaei, N. Liquid biopsy for infectious diseases: sequencing of cell-free plasma to detect pathogen DNA in patients with invasive fungal disease. Diagn Microbiol Infect Dis. 2018;92:210–213. doi: 10.1016/J.DIAGMICROBIO.2018.06.009 CrossRefGoogle ScholarPubMed
Dong, HV, Saleh, T, Kaur, I, Yang, S. Elucidating the Clinical Interpretation and Impact of a Positive Plasma Cell-Free DNA Metagenomics Test Result-A Single Center Retrospective Study. J Appl Lab Med. 2024;9:14–27. doi: 10.1093/JALM/JFAD083 CrossRefGoogle Scholar
Marr, KA, Laverdiere, M, Gugel, A, Leisenring, W. Antifungal therapy decreases sensitivity of the Aspergillus galactomannan enzyme immunoassay. Clin Infect Dis. 2005;40:1762–1769. doi: 10.1086/429921/3/40-12-1762-FIG002.GIF CrossRefGoogle ScholarPubMed
Huygens, S, Schauwvlieghe, A, Wlazlo, N, et al. Diagnostic Value of Microbial Cell-free DNA Sequencing for Suspected Invasive Fungal Infections: A Retrospective Multicenter Cohort Study. Published online 2024. doi: 10.1093/ofid/ofae252 CrossRefGoogle Scholar
Bergin, SP, Chemaly, RF, Dadwal, SS, et al. Plasma Microbial Cell-Free DNA Sequencing in Immunocompromised Patients With Pneumonia: A Prospective Observational Study. Clin Infect Dis. 2024;78:775–784. doi: 10.1093/CID/CIAD599 CrossRefGoogle ScholarPubMed
Hogan, CA, Yang, S, Garner, OB, et al. Clinical Impact of Metagenomic Next-Generation Sequencing of Plasma Cell-Free DNA for the Diagnosis of Infectious Diseases: A Multicenter Retrospective Cohort Study. Clin Infect Dis. 2021;72:239–245. doi: 10.1093/CID/CIAA035 CrossRefGoogle ScholarPubMed
Salem-Bango, Z, Price, TK, Chan, JL, Chandrasekaran, S, Garner, OB, Yang, S. Fungal Whole-Genome Sequencing for Species Identification: From Test Development to Clinical Utilization. J Fungi (Basel). 2023;9: doi: 10.3390/JOF9020183 Google ScholarPubMed