Bacterial cell-free DNA profiling reveals co-elevation of multiple bacteria in newborn foals with suspected sepsis

Background Sepsis is the leading cause of death in newborn foals. This study investigates whether cell-free DNA (cfDNA) sequencing can enhance bacterial pathogen detection in foals with suspected sepsis and addresses existing knowledge gaps and diagnostic challenges. Methods We developed a f oal cf DNA sequencing for b acteria i dentification ( cf FBI ) workflow, integrating wetlab and computational protocols to detect increased bacterial cfDNA abundance in blood. Specifically, cfFBI focusses on enriching bacterial cfDNA molecules and preventing false positive bacterial identifications. cfFBI was applied to blood samples of 25 hospitalized foals categorized according to the neonatal Systemic Inflammatory Response Syndrome (nSIRS) criteria and 7 healthy foals. Results cfDNA levels of potential sepsis-causing bacterial genera were elevated in all 11 nSIRS-positive foals compared to healthy foals (n=7), and in 8/11 (72.7%) when compared to both nSIRS-negative (n=4; nSIRS=0) and healthy foals, with multiple genera elevated in 5/11 (45.5%). The total cfDNA concentration, bacterial cfDNA fraction and bacterial diversity were not different between the foal groups. However, nSIRS-positive foals showed significantly different end-motifs in host chromosomal cfDNA, and a decrease in host mitochondrial cfDNA fraction. Conclusions This study is the first to demonstrate that cfDNA sequencing in blood samples from newborn foals enables detection of pathogenic bacteria and can help identify novel host-related sepsis biomarkers. The elevated presence of multiple sepsis-causing genera in nSIRS-positive foals and the difference in end-motif, suggests that multibacterial elevation may be more common than previously thought. These findings indicate that cfDNA sequencing holds promise as a future diagnostic tool for identifying sepsis in newborn foals.