{"doi":"10.1093/cid/ciac426","title":"Microbial Cell-Free DNA Identifies the Causative Pathogen in Infective Endocarditis and Remains Detectable Longer Than Conventional Blood Culture in Patients with Prior Antibiotic Therapy","abstract":"BACKGROUND: The diagnosis of infective endocarditis (IE) can be difficult, particularly if blood cultures fail to yield a pathogen. This study evaluates the potential utility of microbial cell-free DNA (mcfDNA) as a tool to identify the microbial etiology of IE. METHODS: Blood samples from patients with suspected IE were serially collected. mcfDNA was extracted from plasma and underwent next-generation sequencing. Reads were aligned against a library containing DNA sequences belonging to >1400 different pathogens. mcfDNA from organisms present above a statistical threshold were reported and quantified in molecules per milliliter (MPM). Additional mcfDNA was collected on each subject every 2-3 days for a total of 7 collections or until discharge. RESULTS: Of 30 enrolled patients with suspected IE, 23 had definite IE, 2 had possible IE, and IE was rejected in 5 patients by modified Duke Criteria. Only the 23 patients with definite IE were included for analysis. Both mcfDNA and blood cultures achieved a sensitivity of 87%. The median duration of positivity from antibiotic treatment initiation was estimated to be approximately 38.1 days for mcfDNA versus 3.7 days for blood culture (proportional odds, 2.952; P = .02771), using a semiparametric survival analysis. mcfDNA (log10) levels significantly declined (-0.3 MPM log10 units, 95% credible interval -0.45 to -0.14) after surgical source control was performed (pre- vs postprocedure, posterior probability >0.99). CONCLUSION: mcfDNA accurately identifies the microbial etiology of IE. Sequential mcfDNA levels may ultimately help to individualize therapy by estimating a patient's burden of infection and response to treatment.","journal":"Clinical Infectious Diseases","year":2022,"id":235310,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":82,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.963,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":524084,"name":"Nicholas Degner","orcid":"0000-0003-4578-3726","position":1,"is_corresponding":false},{"id":640060,"name":"Erick R. Scott","orcid":"0000-0002-6594-8623","position":2,"is_corresponding":false},{"id":37805,"name":"Felicia Ruffin","orcid":"0000-0003-2176-6462","position":3,"is_corresponding":false},{"id":624833,"name":"John Franzone","orcid":null,"position":4,"is_corresponding":false},{"id":331149,"name":"Batu K. Sharma‐Kuinkel","orcid":"0000-0002-7217-3213","position":5,"is_corresponding":false},{"id":341468,"name":"Pratik Shah","orcid":"0000-0002-1255-9325","position":6,"is_corresponding":false},{"id":218061,"name":"David K. Hong","orcid":"0000-0003-3152-0618","position":7,"is_corresponding":false},{"id":279901,"name":"Sudeb C. Dalai","orcid":null,"position":8,"is_corresponding":false},{"id":277657,"name":"Lily Blair","orcid":"0000-0002-1175-4882","position":9,"is_corresponding":false},{"id":277656,"name":"Desiree Hollemon","orcid":"0000-0003-4971-9334","position":10,"is_corresponding":false},{"id":853891,"name":"Eliza J Chang","orcid":null,"position":11,"is_corresponding":false},{"id":277655,"name":"Carine Ho","orcid":"0000-0003-2034-9392","position":12,"is_corresponding":false},{"id":470351,"name":"Lisa Wanda","orcid":null,"position":13,"is_corresponding":false},{"id":264753,"name":"Christiaan R. de Vries","orcid":"0000-0002-4667-5973","position":14,"is_corresponding":false},{"id":32929,"name":"Vance G. Fowler","orcid":"0000-0002-8048-0897","position":15,"is_corresponding":false},{"id":633527,"name":"Asim Ahmed","orcid":null,"position":16,"is_corresponding":false},{"id":319849,"name":"Emily M. Eichenberger","orcid":"0000-0002-2469-0638","position":0,"is_corresponding":true}],"reference_count":25,"raw_metadata":null,"created_at":"2026-07-19T00:21:48.116752Z","pmid":"35684984","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}