1225 - Next-Generation Sequencing in Clinical Practice: A Survey of Infectious Disease Providers

Background: Next-generation sequencing (NGS) has emerged as a promising diagnostic tool in Infectious Diseases (ID). The platform offers high sensitivity, detecting difficult-to-isolate organisms. However, limitations remain in employing NGS broadly, including high cost, unstandardized methods, and unclear significance of many results. To date, there is no consensus on appropriate use of NGS. Here, we describe perceived utility of NGS  among ID physicians at one academic medical center.

Methods: A survey exploring four clinical scenarios was disseminated electronically to ID attendings and fellows. Scenarios #1 (immunocompetent patient without localizing signs) and #2 (immunosuppressed patient with localizing signs) were followed by questions exploring likelihood of sending NGS. Scenarios #3 (immunocompetent patient with prosthetic joint infection) and #4 (immunosuppressed patient with cavitary lung lesion) were followed by questions exploring interpretation of NGS data.

Results: Twenty-six physicians responded. Respondents were more likely to send NGS for an immunosuppressed than an immunocompetent patient (8/26 vs. 2/26 respondents, p=0.024), with more respondents noting in the latter casethat NGS might “yield unhelpful/misleading results” (26 /26 vs. 17/23, p=0.0054) or might “not be cost-effective” (21/26 vs. 13/23, p=0.066). Those with over five years of experience tended to be more likely to send NGS (8/27 vs. 2/23 responses across two scenarios, p=0.065), noting more frequently that NGS might “yield a diagnosis not otherwise considered” (16/25 vs. 6/23 responses, p=0.0084) and“avoid painful/high-risk testing” (16/26 vs. 8/23 responses, p=0.062). In scenarios with available NGS data, nearlyhalf (21/49 responses across two scenarios) favored obtaining further diagnostics.

Conclusion: Our results suggest that patient immunosuppression is a salient factor in determining clinical utility of NGS and that physician experience may affect utilization. While NGS is perceived as a useful adjunct to existing data to guide initial management, results are still interpreted with caution and rarely supersede more established methods for definitive diagnosis. Further study is needed to guide evidence-based NGS use.