Table 7.

Karius Test False Negatives at T1

Patient	KT Result	Other SMT Result	Clinical Diagnosis	Antibiotics Received (all)	Case Details
1	Negative	Negative, no tooth cultures	Dental infection	PIP-TAZ; AMOX-CLAV; ERT	Underwent tooth extraction; periodontal disease and “lucencies” on imaging
2	Negative	Tooth abscess culture: Prevotella spp	Dental abscess	PIP-TAZ; VORI	Underwent tooth extraction
3	Negative	Negative	Facial cellulitis	PIP-TAZ; VANC	Jaw pain, swelling, tenderness of left mandibular region—swelling on CT, improved with antimicrobials
4	Negative	Negative	RLE cellulitis	CEF; VANC	Purpura and DVT on the same leg
5	Negative	Negative	Sepsis of unclear etiology	CEF; VANC; VORI; PIP-TAZ; ACV	Persistent fever on day 3 developed shock. Noted hemoglobin drop (7 to 4.8 g/dL); no identified source of bleeding; improvement within 24 hours following steroids, PRBC, and broad antimicrobials
6	Negative	Negative, no fungal cultures, Asp GM and 1,3 BDG negative	Fungal pneumonia	PIP-TAZ; MERO; VORI	CT chest with 7-mm nodule and small areas of GGO
7	Rhizopus spp at T2, T3	BAL: 6 colonies of Aspergillus niger Brain abscess: fungal cultures, fungal sequencing negative Brain histopathology: fungal forms consistent with Rhizopus spp.	Necrotizing fungal pneumonia and brain abscess	CEF; PIP-TAZ; VORI; L-AMB	CT chest: right lower lobe consolidation with surrounding GGO, VORI initiated On day 10, growth of A niger CT chest day 12: progressive cavitating pneumonia, changed to L-AMB. - Day 28; MRI brain: abscess - Day 30: Fungal hyphae identified on tissue

Abbreviations: 1,3 BDG, 1,3 beta-D-glucan; ACV, acyclovir; AMOX-CLAV, amoxicillin-clavulanic; Asp GM, aspergillus galactomannan; CEF, cefepime; CT, computed tomography; ERT, ertapenem; GGO, ground-glass opacities; KT, Karius test; L-AMB, liposomal amphotericin; MERO, meropenem; MRI, magnetic resonance imaging; PIP-TAZ, piperacillin-tazobactam; PRBC, packed red blood cell; RLE, right lower extremity; SMT, standard microbiological testing; VANC, vancomycin; Vori, voriconazole.