{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:19:13Z","timestamp":1788437953765,"version":"build-2803163510"},"reference-count":31,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["13GW0593"],"award-info":[{"award-number":["13GW0593"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Transmed fellowship of the University medical Centre Mainz"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,2,25]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    A patient with a complex urological history presented with abdominal pain and respiratory distress after catheter dysfunction. She underwent emergency surgery for a ruptured urinary pouch. Sepsis was later diagnosed based on clinical deterioration, including tachycardia, fever, an elevated respiratory rate and raised inflammatory markers, but blood cultures remained negative. A metagenomic microbial cell-free DNA (cfDNA) assay (iSEP-SEQ), performed early from plasma as part of a research protocol, identified\n                    <jats:italic>Klebsiella<\/jats:italic>\n                    and\n                    <jats:italic>Pseudomonas<\/jats:italic>\n                    at the genus level. Results were obtained retrospectively and were not available in real time; therefore, they did not alter immediate management. These findings were confirmed by cultures from drainage fluid and urine. Broad-spectrum antibiotic treatment led to clinical improvement. This case highlights the limitations of conventional microbiological methods in culture-negative sepsis and illustrates the role of cfDNA-based metagenomic testing as an adjunctive and complementary diagnostic tool for early, accurate pathogen detection. Early use of such tools may support timely and targeted management in complex infectious disease presentations.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-267878","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T12:30:17Z","timestamp":1779971417000},"page":"e267878","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Plasma metagenomic cfDNA sequencing identifies pathogens in culture-negative sepsis following urinary pouch rupture"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4392-9672","authenticated-orcid":false,"given":"Katharina","family":"Hoeter","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz Department of Anesthesiology, Mainz, Rheinland-Pfalz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Marriott","sequence":"additional","affiliation":[{"name":"School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, Scotland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmo W I","family":"Neuberger","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg University Mainz, Mainz, RP, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urantschimeg","family":"Dagwadordsch","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, RP, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radhe Shantha","family":"Kumar","sequence":"additional","affiliation":[{"name":"University of Cambridge, Cambridge, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perikles","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg University Mainz, Mainz, RP, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Bodenstein","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz Department of Anesthesiology, Mainz, Rheinland-Pfalz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8185-8230","authenticated-orcid":false,"given":"Ma\u00efwenn","family":"Kersaudy-Kerhoas","sequence":"additional","affiliation":[{"name":"School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, Scotland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"2026090305051349000_19.5.e267878.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"2026090305051349000_19.5.e267878.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32989-7"},{"key":"2026090305051349000_19.5.e267878.3","doi-asserted-by":"crossref","DOI":"10.1128\/jcm.00231-21","article-title":"Direct-from-Blood Detection of Pathogens: a Review of Technology and Challenges","volume":"61","author":"Samuel","year":"2023","journal-title":"J Clin Microbiol"},{"key":"2026090305051349000_19.5.e267878.4","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-55635-z"},{"key":"2026090305051349000_19.5.e267878.5","doi-asserted-by":"crossref","DOI":"10.1128\/jcm.01498-23","article-title":"Culture-independent identification of bloodstream infections from whole blood: prospective evaluation in specimens of known infection status","volume":"62","author":"Iyer","year":"2024","journal-title":"J Clin Microbiol"},{"key":"2026090305051349000_19.5.e267878.6","doi-asserted-by":"publisher","DOI":"10.7150\/thno.45554"},{"key":"2026090305051349000_19.5.e267878.7","doi-asserted-by":"crossref","unstructured":"Marriott L , Martinez Lopez A , Liga A , et al . 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