Clinical Metagenomics for Bloodstream Infections: Is the Juice Worth the Squeeze?
N. Esther Babady
Abstract
(See the Major Article by Hogan et al on pages 239–45.) Bloodstream infections (BSIs) are a significant cause of morbidity and mortality, accounting for $20 billion in hospitalization costs and high in-hospital mortality [1]. In the current surviving sepsis guidelines, blood culture is the only microbiology test recommended to support the diagnosis of sepsis [2]. However, blood culture has limited sensitivity (ranging from 5% to 50%) and is affected by several preanalytical variables including timing of collection (eg, before or after initiation of antimicrobial therapy) and volume of blood collected [3, 4]. In 2014, Charles Chiu and colleagues from the University of California, San Francisco (UCSF) reported the first use of unbiased, next-generation sequencing (NGS) on cerebrospinal fluid (CSF) to diagnose a case of neuroleptospirosis in a 14-year-old boy presenting with meningoencephalitis [5]. Fewer than 500 reads (out of...