Plasma Quantitative Microbial Cell-Free DNA for Staphylococcal Cardiac Implantable Electronic Device Infection—Too Soon?

We read with great interest the study by Karchmer et al. [1], which explored the role of quantitative microbial cell-free DNA (mcfDNA) as a biomarker in diagnosing and managing staphylococcal cardiac implantable electronic device infection (CIEDI).The authors serially measured mcfDNA in 11 patients with "definite" and five with "possible" CIEDI before and after device extraction.They observed prolonged mcfDNA persistence post-extraction in patients with "definite" CIEDI while rapidly declined in "possible" CIEDI, suggesting that serial mcfDNA measurements could enhance diagnostic accuracy, as well as potentially spare some patients from unnecessary device extraction, prolonged hospitalization and extended antibiotic therapy.