P-837. Effect of Clinical Guideline Implementation on Use of Plasma Microbial Cell-free DNA Sequencing Testing at an Academic Medical Center
Abstract
Abstract Background The role and timing of plasma microbial cell-free DNA (mcfDNA) testing is unknown. We created a guideline for use arranged by clinical syndrome and evaluated changes in testing, results, and impact on patient care pre- and post-guideline. Table 1: Population Demographics Table 2: Clinical Impact of mcfDNA Testing Methods The stewardship program created a clinical guideline with input from microbiology and ID providers regarding use and timing of mcfDNA testing. It was published online 3/2024 with accompanying brief education to ID. We compared mcfDNA testing pre- (4/2023-2/2024) and post-guideline (3/2024-12/2024). Testing appropriateness was assessed based on institutional guidance. Indication for testing, clinical significance and impact was determined using clinical documentation. Results A total of 147 mcfDNA tests were ordered on 142 patients with demographics in Table 1. Most tests were in immunocompromised patients. Testing increased slightly post-guideline (4.3 vs. 5.2 tests/10000 PD). mcfDNA tests were positive in 75% tested for a median of 2 pathogens with at least some results confirmed by other testing in 41% (Table 2). Post-guideline testing for Other and Respiratory diagnoses decreased but testing by Oncology ID increased (16.9% vs. 39.5%) with a 6-fold increase in use for suspected Invasive Fungal Infection (IFI) (4.2% vs. 23.7%). Only 23% of mcfDNA tests were considered clinically significant by providers (pre- 26.7% vs. 20.0% post-).…
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