title: Metagenomic analysis of bloodstream infections in patients with acute leukemia and therapy-induced neutropenia.
abstract: Leukemic patients are often immunocompromised due to underlying conditions, comorbidities and the effects of chemotherapy, and thus at risk for developing systemic infections. Bloodstream infection (BSI) is a severe complication in neutropenic patients, and is associated with increased mortality. BSI is routinely diagnosed with blood culture, which only detects culturable pathogens. We analyzed 27 blood samples from 9 patients with acute leukemia and suspected BSI at different time points of their antimicrobial treatment using shotgun metagenomics sequencing in order to detect unculturable and non-bacterial pathogens. Our findings confirm the presence of bacterial, fungal and viral pathogens alongside antimicrobial resistance genes. Decreased white blood cell (WBC) counts were associated with the presence of microbial DNA, and was inversely proportional to the number of sequencing reads. This study could indicate the use of high-throughput sequencing for personalized antimicrobial treatments in BSIs.
authors.affiliation: Karolinska Institutet, Department of Laboratory Medicine, Alfred Nobels Allé 8, Stockholm, 17177 Sweden.|Karolinska University Hospital, Department of Clinical Microbiology L2:02, Stockholm, 17176 Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Gyarmati
authors.affiliation: Karolinska Institutet, Department of Medicine, Division of Hematology, Stockholm, 17176 Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Kjellander
authors.affiliation: Karolinska Institutet, Department of Medicine, Solna, Infectious Diseases Unit, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, 17176 Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Aust
authors.affiliation: Royal Institute of Technology, Science for Life Laboratory, Stockholm, 17176 Sweden.
authors.forename: Y
authors.initials: Y
authors.lastname: Song
authors.affiliation: Karolinska Institutet, Department of Medicine, Solna, Infectious Diseases Unit, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, 17176 Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Öhrmalm
authors.affiliation: Karolinska Institutet, Department of Laboratory Medicine, Alfred Nobels Allé 8, Stockholm, 17177 Sweden.|Karolinska University Hospital, Department of Clinical Microbiology L2:02, Stockholm, 17176 Sweden.
authors.forename: C G
authors.initials: CG
authors.lastname: Giske
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D004271:DNA, Fungal / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D006801:Humans; D007951:Leukemia, Myeloid / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000821:virology*; D056186:Metagenomics; D009503:Neutropenia / Q000139:chemically induced / Q000382:microbiology* / Q000821:virology*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004271:DNA, Fungal; D004279:DNA, Viral