Infectious DiseasesAXISNCT07825714
Metagenomic Sequencing Across the Infectious Disease Risk and Care Continuum
An observational study of Infectious Diseases and Immunocompromised Host, run by Karius, Inc..
Trial summary
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. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Infectious Diseases, Immunocompromised Host, Opportunistic Infections
- How many people
- 10,000 participants
- Where
- No sites listed yet
- Study dates
- Oct 2026to Dec 2033
- How long will I take part?
- 12 Months
- Phase
- Observational
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: 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.
Who may be able to join
- 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.
Who cannot join
- 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.
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: 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.
Read the detailed description
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.
- Keywords
- Metagenomic Sequencing, Microbial Cell-Free DNA, Karius Spectrum, Infectious Disease Diagnostics, Precision Diagnostics, Real-World Evidence, Observational Registry, Immunocompromised Host, Hematologic Malignancy, Solid Organ Transplant, Stem Cell Transplant, Opportunistic Infection, Diagnostic Stewardship, Clinical Decision Making, Healthcare Utilization
- Medical subject headings
- Communicable Diseases, Opportunistic Infections, Hematologic Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| 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. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Time to Antimicrobial Modification Following Karius Spectrum Result Availability
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.
Measured: From Karius Spectrum result availability through hospital discharge and up to 90 days following discharge (not to exceed 12 months).
Secondary outcomes (20)
Participants With Antimicrobial Modification
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.
Measured: From enrollment through 90 days following discharge from the index hospitalization, up to 12 months
Number of Infection-Directed Microbiological Diagnostic Tests
Number of infection-directed microbiological diagnostic tests performed during the index encounter, summarized by test type.
Measured: From Time Zero through discharge from the index hospitalization, up to 12 months
Invasive Diagnostic Procedures Ordered Following Karius Spectrum Result Availability
Number of invasive diagnostic procedures ordered following Karius Spectrum result availability, summarized by procedure type.
Measured: From Karius Spectrum result availability through discharge from the index hospitalization, up to 12 months
Hospital Length of Stay From Admission
Hospital length of stay calculated as the number of days from admission to discharge from the index hospitalization.
Measured: During the index hospitalization, from admission through discharge, up to 12 months
Incidence of Intensive Care Unit Transfer
Proportion of participants who experience transfer to an intensive care unit during the index hospitalization.
Measured: During the index hospitalization, from admission through discharge, up to 12 months
Incidence of Mechanical Ventilation
Proportion of participants requiring mechanical ventilation during the index hospitalization.
Measured: During the index hospitalization, from admission through discharge, up to 12 months
In-Hospital Mortality
Incidence of mortality during the index hospitalization.
Measured: During the index hospitalization, from admission through discharge, up to 12 months
30-Day Mortality
Incidence of mortality within 30 days following hospital discharge.
Measured: Through 30 days following hospital discharge.
30-Day Readmission
Incidence of hospital readmission within 30 days following hospital discharge.
Measured: Through 30 days following hospital discharge.
Clostridioides difficile Infection
Incidence of Clostridioides difficile infection during the study period.
Measured: Enrollment through 30 days following hospital discharge.
Immunosuppressive Therapy Modifications
Proportion of participants with any immunosuppressive therapy modification within a specified timeframe following usual-care or Karius Spectrum result availability.
Measured: Baseline through 30 days following hospital discharge.
Species-Level Pathogen Identification by Karius Spectrum Compared With Usual Care
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.
Measured: From Time Zero through discharge from the index hospitalization, up to 12 months
Antimicrobial Days
Number of days of antimicrobial therapy, summarized by antimicrobial spectrum, antimicrobial type, and route of administration.
Measured: From enrollment through 90 days following discharge from the index hospitalization, up to 12 months
Number of Diagnostic Imaging Studies
Number of diagnostic imaging studies performed during the index encounter, summarized by imaging type.
Measured: From Time Zero through discharge from the index hospitalization, up to 12 months
Number of Invasive Diagnostic Procedures
Number of invasive diagnostic procedures performed during the index encounter, including procedures such as needle aspiration and bronchoscopy.
Measured: From Time Zero through discharge from the index hospitalization, up to 12 months
Invasive Diagnostic Procedures Cancelled Following Karius Spectrum Result Availability
Number of invasive diagnostic procedures cancelled following Karius Spectrum result availability, summarized by procedure type.
Measured: From Karius Spectrum result availability through discharge from the index hospitalization, up to 12 months
Hospital Length of Stay From Time Zero
Hospital length of stay calculated as the number of days from Time Zero to discharge from the index hospitalization.
Measured: From Time Zero through discharge from the index hospitalization, up to 12 months
Timing of Intensive Care Unit Transfer Relative to Time Zero
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.
Measured: During the index hospitalization, from admission through discharge, up to 12 months
Timing of Mechanical Ventilation Relative to Time Zero
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.
Measured: During the index hospitalization, from admission through discharge, up to 12 months
Ventilator Days
Number of ventilator-days among participants requiring mechanical ventilation.
Measured: During the index hospitalization, from initiation of mechanical ventilation through discontinuation or discharge, up to 12 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted17 Sep 2026
- Study startOct 2026 (estimated)
- Primary completionDec 2033 (estimated)
- Study completionDec 2033 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Infectious DiseasesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 10,000 participants (estimated)
- Target duration
- 12 Months
Sponsor and investigators
- Lead sponsor
- Karius, Inc.
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Kat Kwiatkowski, PhD, Principal investigator, Karius, Inc.
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07825714
- Sponsor's protocol ID
- KAR-0040
- Acronym
- AXIS
- Status last verified
- Sep 2026
- First submitted
- 25 Jun 2026
- Last updated
- 17 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No