Metagenomic Sequencing Across the Infectious Disease Risk and Care Continuum (AXIS)
A Prospective, Multicenter Registry to Evaluate Metagenomic Sequencing Across the Infectious Disease Risk and Care Continuum
The AXIS Network is a prospective, multicenter observational registry designed to generate real-world evidence on the use of metagenomic sequencing in clinical practice across a broad range of patient populations, infectious disease syndromes, and clinical care settings.
Participants receiving routine clinical care at participating institutions may be enrolled into cohort-specific registries that evaluate how metagenomic sequencing is used for diagnostic evaluation, surveillance of high-risk populations, or longitudinal monitoring of treatment response. The study does not assign participants to any intervention, alter standard clinical care, or require study-mandated testing or treatment. Instead, it collects clinical information generated during routine care, including diagnostic testing, antimicrobial use, clinical management decisions, healthcare utilization, and clinical outcomes.
The primary objective of AXIS is to evaluate how metagenomic sequencing informs clinical decision-making and is associated with downstream management and clinical outcomes. Secondary objectives include characterization of test utilization patterns, diagnostic integration, antimicrobial management decisions, healthcare utilization, and longitudinal monitoring strategies. Data collected through AXIS may also support development of predictive models and clinical decision-support tools.
調査の概要
詳細な説明
The AXIS Network is a prospective, multicenter observational registry designed to evaluate the real-world use of metagenomic sequencing across the infectious disease care continuum. The registry serves as a scalable platform for generating real-world evidence regarding how sequencing-based infectious disease diagnostics are utilized in clinical practice and how diagnostic information influences patient management and outcomes.
AXIS is structured as a master protocol with modular cohort appendices that allow evaluation of metagenomic sequencing across diverse patient populations, clinical syndromes, care settings, specimen types, and clinical use contexts. Cohorts may include participants undergoing metagenomic sequencing as part of routine clinical care, participants receiving usual-care diagnostic testing without sequencing, or both, depending on the objectives of the specific cohort.
The registry is designed to evaluate metagenomic sequencing in several clinical contexts, including:
Diagnostic evaluation of patients with suspected infection Surveillance of populations at increased risk for infection Longitudinal monitoring of treatment response or recurrent infection
AXIS places particular emphasis on immunocompromised populations, including patients with hematologic malignancies, solid organ transplant recipients, hematopoietic stem cell transplant recipients, individuals receiving immunosuppressive therapies, and other high-risk populations. Both adult and pediatric participants may be enrolled, depending on cohort-specific eligibility criteria.
No study-mandated interventions, treatments, or diagnostic procedures are performed. All diagnostic testing and clinical management decisions are made by treating clinicians according to routine clinical practice. Data are collected through a combination of standardized case report forms and structured extraction of electronic health record data.
Data collected may include:
Demographic and baseline clinical characteristics Diagnostic testing and timing of results Antimicrobial administration and management decisions Procedures and healthcare utilization Clinical outcomes, including mortality and readmissions Longitudinal follow-up information, where applicable
The primary objective of AXIS is to evaluate how metagenomic sequencing informs clinical decision-making and its association with downstream management decisions and clinical outcomes across defined cohorts.
Secondary objectives include:
Characterizing real-world utilization patterns of metagenomic sequencing Describing integration of sequencing results into diagnostic evaluation Evaluating infection-related clinical management decisions associated with sequencing results Assessing longitudinal monitoring and surveillance applications Evaluating healthcare utilization outcomes
Exploratory objectives include assessment of patient-centered outcomes, development of predictive models and clinical decision-support approaches, and establishment of an interactome biobank utilizing residual clinical specimens where permitted.
Approximately 50 sites in the United States are expected to participate. The registry is designed to enroll up to approximately 10,000 participants over a planned study duration of approximately seven years. Data generated through AXIS are intended to improve understanding of how metagenomic sequencing is used in routine clinical practice and to inform future research, clinical care strategies, and diagnostic innovation.
研究の種類
入学 (推定)
連絡先と場所
研究連絡先
- 名前：Kat Kwiatkowsi
- 電話番号：910-232-6396
- メール：kat.kwiatkowski@kariusdx.com
研究連絡先のバックアップ
- 名前：Mona Mughar
- 電話番号：8653082690
- メール：mona.mughar@kariusdx.com
参加基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
サンプリング方法
調査対象母集団
Participants receiving routine clinical care at participating institutions who meet eligibility criteria for one or more active AXIS cohorts. Cohorts may evaluate metagenomic sequencing for diagnostic evaluation, surveillance, or longitudinal monitoring across a range of infectious disease syndromes, patient populations, and healthcare settings.
This approach prevents you from having to amend the NCT record every time AXIS expands beyond hospitalized immunocompromised patients with lower respiratory infections. It also aligns with how platform registries and master protocols are typically registered.
説明
Inclusion Criteria:
- Participant receives care at a participating AXIS site.
- Participant meets eligibility criteria for at least one active AXIS cohort as defined in the applicable cohort appendix.
- Participant or legally authorized representative is able to provide informed consent, unless waived by the reviewing IRB.
Exclusion Criteria:
- Any condition that, in the opinion of the investigator, would make participation inappropriate or prevent completion of required study procedures.
- Additional cohort-specific exclusion criteria may apply and are defined within the applicable cohort appendix.
研究計画
研究はどのように設計されていますか？
デザインの詳細
コホートと介入
グループ/コホート |
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Hospitalized Immunocompromised Adults With Suspected Lower Respiratory Infection
Hospitalized immunocompromised adults with clinical evidence of lower respiratory infection who undergo Karius Spectrum plasma microbial cell-free DNA metagenomic sequencing as part of routine clinical care.
Participants are enrolled in a prospective observational registry and are not assigned to any study-directed intervention.
Clinical data are collected through routine care and electronic health record review to evaluate associations between metagenomic sequencing results, antimicrobial management decisions, diagnostic testing utilization, healthcare utilization, and clinical outcomes.
Participants are followed through hospital discharge and for up to 90 days following discharge, not to exceed 12 months total follow-up.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Time to Antimicrobial Modification Following Karius Spectrum Result Availability
時間枠：From Karius Spectrum result availability through hospital discharge and up to 90 days following discharge (not to exceed 12 months).
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Time from Karius Spectrum result availability to first antimicrobial modification, including initiation, escalation, de-escalation, discontinuation, change in route of administration, or change in duration of therapy.
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From Karius Spectrum result availability through hospital discharge and up to 90 days following discharge (not to exceed 12 months).
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Participants With Antimicrobial Modification
時間枠：From enrollment through 90 days following discharge from the index hospitalization, up to 12 months
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Proportion of participants with at least one antimicrobial modification, including initiation, escalation, de-escalation, discontinuation, change in route of administration, or change in duration of therapy.
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From enrollment through 90 days following discharge from the index hospitalization, up to 12 months
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Number of Infection-Directed Microbiological Diagnostic Tests
時間枠：From Time Zero through discharge from the index hospitalization, up to 12 months
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Number of infection-directed microbiological diagnostic tests performed during the index encounter, summarized by test type.
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From Time Zero through discharge from the index hospitalization, up to 12 months
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Invasive Diagnostic Procedures Ordered Following Karius Spectrum Result Availability
時間枠：From Karius Spectrum result availability through discharge from the index hospitalization, up to 12 months
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Number of invasive diagnostic procedures ordered following Karius Spectrum result availability, summarized by procedure type.
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From Karius Spectrum result availability through discharge from the index hospitalization, up to 12 months
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Hospital Length of Stay From Admission
時間枠：During the index hospitalization, from admission through discharge, up to 12 months
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Hospital length of stay calculated as the number of days from admission to discharge from the index hospitalization.
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During the index hospitalization, from admission through discharge, up to 12 months
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Incidence of Intensive Care Unit Transfer
時間枠：During the index hospitalization, from admission through discharge, up to 12 months
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Proportion of participants who experience transfer to an intensive care unit during the index hospitalization.
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During the index hospitalization, from admission through discharge, up to 12 months
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Incidence of Mechanical Ventilation
時間枠：During the index hospitalization, from admission through discharge, up to 12 months
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Proportion of participants requiring mechanical ventilation during the index hospitalization.
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During the index hospitalization, from admission through discharge, up to 12 months
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In-Hospital Mortality
時間枠：During the index hospitalization, from admission through discharge, up to 12 months
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Incidence of mortality during the index hospitalization.
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During the index hospitalization, from admission through discharge, up to 12 months
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30-Day Mortality
時間枠：Through 30 days following hospital discharge.
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Incidence of mortality within 30 days following hospital discharge.
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Through 30 days following hospital discharge.
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30-Day Readmission
時間枠：Through 30 days following hospital discharge.
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Incidence of hospital readmission within 30 days following hospital discharge.
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Through 30 days following hospital discharge.
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Clostridioides difficile Infection
時間枠：Enrollment through 30 days following hospital discharge.
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Incidence of Clostridioides difficile infection during the study period.
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Enrollment through 30 days following hospital discharge.
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Immunosuppressive Therapy Modifications
時間枠：Baseline through 30 days following hospital discharge.
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Proportion of participants with any immunosuppressive therapy modification within a specified timeframe following usual-care or Karius Spectrum result availability.
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Baseline through 30 days following hospital discharge.
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Species-Level Pathogen Identification by Karius Spectrum Compared With Usual Care
時間枠：From Time Zero through discharge from the index hospitalization, up to 12 months
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Proportion of participants with a Karius Spectrum identification at the species level for which usual-care diagnostic testing has no corresponding detection or only a genus-level detection.
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From Time Zero through discharge from the index hospitalization, up to 12 months
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Antimicrobial Days
時間枠：From enrollment through 90 days following discharge from the index hospitalization, up to 12 months
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Number of days of antimicrobial therapy, summarized by antimicrobial spectrum, antimicrobial type, and route of administration.
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From enrollment through 90 days following discharge from the index hospitalization, up to 12 months
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Number of Diagnostic Imaging Studies
時間枠：From Time Zero through discharge from the index hospitalization, up to 12 months
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Number of diagnostic imaging studies performed during the index encounter, summarized by imaging type.
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From Time Zero through discharge from the index hospitalization, up to 12 months
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Number of Invasive Diagnostic Procedures
時間枠：From Time Zero through discharge from the index hospitalization, up to 12 months
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Number of invasive diagnostic procedures performed during the index encounter, including procedures such as needle aspiration and bronchoscopy.
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From Time Zero through discharge from the index hospitalization, up to 12 months
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Invasive Diagnostic Procedures Cancelled Following Karius Spectrum Result Availability
時間枠：From Karius Spectrum result availability through discharge from the index hospitalization, up to 12 months
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Number of invasive diagnostic procedures cancelled following Karius Spectrum result availability, summarized by procedure type.
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From Karius Spectrum result availability through discharge from the index hospitalization, up to 12 months
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Hospital Length of Stay From Time Zero
時間枠：From Time Zero through discharge from the index hospitalization, up to 12 months
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Hospital length of stay calculated as the number of days from Time Zero to discharge from the index hospitalization.
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From Time Zero through discharge from the index hospitalization, up to 12 months
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Timing of Intensive Care Unit Transfer Relative to Time Zero
時間枠：During the index hospitalization, from admission through discharge, up to 12 months
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Timing of intensive care unit transfer relative to Time Zero among participants who experience an ICU transfer, characterized according to whether transfer occurs before or after Time Zero.
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During the index hospitalization, from admission through discharge, up to 12 months
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Timing of Mechanical Ventilation Relative to Time Zero
時間枠：During the index hospitalization, from admission through discharge, up to 12 months
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Timing of initiation of mechanical ventilation relative to Time Zero among participants requiring mechanical ventilation, characterized according to whether initiation occurs before or after Time Zero.
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During the index hospitalization, from admission through discharge, up to 12 months
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Ventilator Days
時間枠：During the index hospitalization, from initiation of mechanical ventilation through discontinuation or discharge, up to 12 months
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Number of ventilator-days among participants requiring mechanical ventilation.
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During the index hospitalization, from initiation of mechanical ventilation through discontinuation or discharge, up to 12 months
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協力者と研究者
スポンサー
捜査官
- 主任研究者：Kat Kwiatkowski, PhD、Karius, Inc.
研究記録日
主要日程の研究
研究開始 (推定)
一次修了 (推定)
研究の完了 (推定)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
キーワード
その他の研究ID番号
- KAR-0040
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