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Burban A, Słupik D, Reda A, Szczerba E, Grabowski M, Kołodzińska A. Novel Diagnostic Methods for Infective Endocarditis. Int J Mol Sci 2024; 25:1245. [PMID: 38279244 PMCID: PMC10816594 DOI: 10.3390/ijms25021245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Infective endocarditis (IE) remains a dangerous disease and continues to have a high mortality rate. Unfortunately, despite continuous improvements in diagnostic methods, in many cases, blood cultures remain negative, and the pathogen causing endocarditis is unknown. This makes targeted therapy and the selection of appropriate antibiotics impossible. Therefore, we present what methods can be used to identify the pathogen in infective endocarditis. These are mainly molecular methods, including PCR and MGS, as well as imaging methods using radiotracers, which offer more possibilities for diagnosing IE. However, they are still not widely used in the diagnosis of IE. The article summarizes in which cases we should choose them and what we are most hopeful about in further research into the diagnosis of IE. In addition, registered clinical trials that are currently underway for the diagnosis of IE are also presented.
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Affiliation(s)
- Anna Burban
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dorota Słupik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Reda
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Ewa Szczerba
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Agnieszka Kołodzińska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
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Kubiak J, Morgan A, Kirmaier A, Arnaout R, Riedel S. Universal PCR for bacteria, mycobacteria, and fungi: a 10-year retrospective review of clinical indications and patient outcomes. J Clin Microbiol 2023; 61:e0095223. [PMID: 38014970 PMCID: PMC10729690 DOI: 10.1128/jcm.00952-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE Our work provides a retrospective analysis of universal PCR orders for bacteria, mycobacteria, and fungi across our institution across a 10-year period. We assessed the positivity rates for this diagnostic tool by test type and specimen type and, critically, studied whether and how the results influenced the outcomes from treatment change, to readmission, to death.
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Affiliation(s)
- Jeffrey Kubiak
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alexandra Morgan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andrea Kirmaier
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ramy Arnaout
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Stefan Riedel
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Johansson G, Sunnerhagen T, Ragnarsson S, Rasmussen M. Clinical Significance of a 16S-rDNA Analysis of Heart Valves in Patients with Infective Endocarditis: a Retrospective Study. Microbiol Spectr 2023; 11:e0113623. [PMID: 37195215 PMCID: PMC10269717 DOI: 10.1128/spectrum.01136-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023] Open
Abstract
A substantial proportion of patients with infective endocarditis (IE) are subjected to heart valve surgery. Microbiological findings on valves are important both for diagnostics and for tailored antibiotic therapy, post-operatively. The aims of this study were to describe microbiological findings on surgically removed valves and to examine the diagnostic benefits of 16S-rDNA PCR and sequencing (16S-analysis). Adult patients who were subjected to heart valve surgery for IE between 2012 and 2021 at Skåne University Hospital, Lund, where a 16S-analysis had been performed on the valve, constituted the study population. Data were gathered from medical records, and the results from blood cultures, valve cultures, and 16S-analyses of valves were compared. A diagnostic benefit was defined as providing an agent in blood culture negative endocarditis, providing a new agent in episodes with positive blood cultures, or confirming one of the findings in episodes with a discrepancy between blood and valve cultures. 279 episodes in 272 patients were included in the final analysis. Blood cultures were positive in 259 episodes (94%), valve cultures in 60 episodes (22%), and 16S-analyses in 227 episodes (81%). Concordance between the blood cultures and the 16S-analysis was found in 214 episodes (77%). The 16S-analyses provided a diagnostic benefit in 25 (9.0%) of the episodes. In blood culture negative endocarditis, the 16S-analyses had a diagnostic benefit in 15 (75%) of the episodes. A 16S-analysis should be routinely performed on surgically removed valves in blood culture negative endocarditis. In patients with positive blood cultures, 16S-analysis may also be considered, as a diagnostic benefit was provided in some patients. IMPORTANCE This work demonstrates that it can be of importance to perform both cultures and analysis using 16S-rDNA PCR and sequencing of valves excised from patients undergoing surgery for infective endocarditis. 16S-analysis may help both to establish a microbiological etiology in cases of blood culture negative endocarditis and to provide help in situations where there are discrepancies between valve and blood cultures. In addition, our results show a high degree of concordance between blood cultures and 16S-analyses, indicating that the latter has a high sensitivity and specificity for the etiological diagnosis of endocarditis in patients who were subjected to heart valve surgery.
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Affiliation(s)
- Gustav Johansson
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medial Services, Region Skåne, Lund, Sweden
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sigurdur Ragnarsson
- Division of Cardiothoracic Surgery, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
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Kotova EO, Moiseeva AY, Kobalava ZD, Domonova EA, Pisaruk AS, Silveistrova OY, Kakhktsyan PV, Vladimirov VV. Effect of Antibiotic Therapy on the Sensitivity of Etiological Diagnostic Methods in Patients with Infective Endocarditis after Surgery. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2023. [DOI: 10.20996/1819-6446-2023-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Aim. Assessment of impact of the duration of preoperative antimicrobial therapy (AMT) on the sensitivity of microbiological examination and polymerase chain reaction (PCR) of blood/tissues of resected valves in operated patients with infective endocarditis (IE).Materials and methods. 52 operated patients with active IE were included prospectively (Duke criteria, 2015). All patients underwent microbiological examination of blood before admission to the cardiac surgery hospital, as well as parallel simultaneous microbiological examination and PCR of blood/tissues of excised valves, followed by Sanger sequencing. The duration of preoperative treatment was calculated from the first day of AMT according to IE diagnosis to the day of surgery.Results. The causative agent of IE was established in 84.6% (n=44) patients by means of complex etiological diagnosis. A significant decrease in the sensitivity of microbiological examination of venous blood was revealed when performed in the period before and after hospitalization to a surgical hospital (up 44.2% to 17.3%, p<0.05). When comparing microbiological examination of blood/tissues of resected valves and PCR of blood/tissues of resected valves, molecular biological methods demonstrated the greatest sensitivity, with a great advantage when examining the tissues of resected valves (17.3% and 19.2% vs. 38.5% and 75.0%, respectively; p<0.001). The microbiological examination of venous blood performed at an early date before admission to the cardiac surgery hospital was comparable in sensitivity to the PCR blood test performed at a later date after prolonged AMT, and significantly less sensitive in relation to the PCR of resected valve tissues [44.2% and 38.5% (p>0.05) vs. 75.0% (p<0.05)]. In course of AMT 1-28 days, there were comparable results of microbiological examination with PCR blood examination and significantly better results of PCR of resected valve tissues [31.0% and 34.5% and 41.4% (p>0.05) vs 72.4% (p<0.001), respectively], and with AMT ≥ 29 days, microbiological examination of any biological material was negative in all patients, and PCR of blood/tissues of resected valves retained high sensitivity (0% and 0% vs. 34.8% and 78.3%, respectively; p<0.01).Conclusion. Long-term preoperative AMT significantly reduced the sensitivity of microbiological examination of resected valve blood/tissue in operated patients with IE, whereas PCR of resected valve blood/tissue was highly sensitive even with preoperative AMT for more than 29 days.
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Affiliation(s)
- E. O. Kotova
- Peoples’ Friendship University of Russia (RUDN); City Hospital named after V.V. Vinogradov
| | | | - Zh. D. Kobalava
- Peoples’ Friendship University of Russia (RUDN); City Hospital named after V.V. Vinogradov
| | - E. A. Domonova
- Central Research Institute of Epidemiology of The Federal Service on Customers' Rights Protection and Human Well-being Surveillance
| | - A. S. Pisaruk
- Peoples’ Friendship University of Russia (RUDN); City Hospital named after V.V. Vinogradov
| | - O. Yu. Silveistrova
- Central Research Institute of Epidemiology of The Federal Service on Customers' Rights Protection and Human Well-being Surveillance
| | - P. V. Kakhktsyan
- A.N. Bakulev National Medical Research Center of Cardiovascular Surgery
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Kotova EO, Domonova EA, Kobalava ZD, Moiseeva AY, Pisaryuk AS, Silveystrova OY, Karaulova JL, Akimkin VG. [Clinical and diagnostic value of including PCR blood test in the traditional algorithm for identifying causative agents of infective endocarditis: a cohort study of 124 patients]. TERAPEVT ARKH 2023; 95:23-31. [PMID: 37167112 DOI: 10.26442/00403660.2023.01.202042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND If infective endocarditis (IE) is suspected, the determination of the etiology is of fundamental importance for the verification of the disease and the appointment of effective therapy. Microbiological diagnostic features are important, but they often need to be supplemented by culture-independent studies of pathological agents. AIM To investigate of the diagnostic advantage and value of quantitative analysis of molecular biological methods (polymerase chain reaction - PCR, sequencing) in addition to microbiological examination of whole venous blood in IE. MATERIALS AND METHODS We examined 124 patients with suspected or significant IE (DUKE 2015) hospitalized in the Vinogradov City Clinical Hospital (2015-2021). All patients underwent parallel microbiological (cultural) and molecular biological (PCR or PCR followed by sequencing) examination of venous whole blood samples. RESULTS The introduction of an early parallel PCR study into the algorithm for the etiological diagnosis of IE made it possible to obtain an additional advantage in 43/124 (34.7%) patients, which made it possible to exclude unreliable results in the determination of CoNS skin commensals and pathogens atypical for IE or contamination and identify the true pathogens, and also for the first time to isolate the etiopathogenetic pathogen with a negative microbiological study. It was shown that in IE associated with CoNS, the association with the disease was confirmed by PCR in 21.4% (3/14) and refuted in 71.4% (10/14). The coincidence of the results of microbiological and PCR studies of blood samples was obtained only in 35/95 (36.8%). Positive results of PCR analysis of blood of biological material with negative results of culture were obtained in 22/51 (43.1%), of which 2/22 (9.0%) were able to confirm the presence of Bartonella spp DNA. The presented complex algorithm made it possible to significantly increase the possibility of intravital identification of the pathogen in the blood from 58.9 to 76.6%. IE with unknown etiology was present in 29/124 (23.4%) patients. A parallel PCR study allowed timely correction of antibiotic therapy in 43/124 (34.7%) patients. CONCLUSION Expansion of indications for the use of PCR studies, primarily whole venous blood samples, is justified, not only in IE with negative results of microbiological examination, but also as a control method for the reliability of the results of traditional (cultural) diagnostic methods.
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Affiliation(s)
- E O Kotova
- People's Friendship University of Russia (RUDN University)
- Vinogradov City Clinical Hospital
| | | | - Z D Kobalava
- People's Friendship University of Russia (RUDN University)
- Vinogradov City Clinical Hospital
| | - A Y Moiseeva
- People's Friendship University of Russia (RUDN University)
| | - A S Pisaryuk
- People's Friendship University of Russia (RUDN University)
- Vinogradov City Clinical Hospital
| | | | - J L Karaulova
- People's Friendship University of Russia (RUDN University)
- Vinogradov City Clinical Hospital
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Kouijzer JJP, Noordermeer DJ, van Leeuwen WJ, Verkaik NJ, Lattwein KR. Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies. Front Cell Dev Biol 2022; 10:995508. [PMID: 36263017 PMCID: PMC9574252 DOI: 10.3389/fcell.2022.995508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening microbial infection of native and prosthetic heart valves, endocardial surface, and/or indwelling cardiac device. Prevalence of IE is increasing and mortality has not significantly improved despite technological advances. This review provides an updated overview using recent literature on the clinical presentation, diagnosis, imaging, causative pathogens, treatment, and outcomes in native valve, prosthetic valve, and cardiac device-related IE. In addition, the experimental approaches used in IE research to improve the understanding of disease mechanisms and the current diagnostic pipelines are discussed, as well as potential innovative diagnostic and therapeutic strategies. This will ultimately help towards deriving better diagnostic tools and treatments to improve IE patient outcomes.
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Affiliation(s)
- Joop J. P. Kouijzer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
- *Correspondence: Joop J. P. Kouijzer,
| | - Daniëlle J. Noordermeer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wouter J. van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kirby R. Lattwein
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Egli K, Risch M, Risch L, Bodmer T. Comparison of an automated DNA extraction and 16S rDNA real time PCR/sequencing diagnostic method using optimized reagents with culture during a 15-month study using specimens from sterile body sites. BMC Microbiol 2022; 22:119. [PMID: 35501697 PMCID: PMC9063205 DOI: 10.1186/s12866-022-02542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background 16S rDNA-PCR for the identification of a bacterial species is an established method. However, the DNA extraction reagents as well as the PCR reagents may contain residual bacterial DNA, which consequently generates false-positive PCR results. Additionally, previously used methods are frequently time-consuming. Here, we describe the results obtained with a new technology that uses DNA-free reagents for automated DNA extraction and subsequent real time PCR using sterile clinical specimens. Results In total, we compared 803 clinical specimens using real time PCR and culturing. The clinical specimens were mainly of orthopedic origin received at our diagnostic laboratory. In 595 (74.1%) samples, the results were concordant negative, and in 102 (12.7%) the results were concordant positive. A total of 170 (21.2%) clinical specimens were PCR-positive, of which 62 (36.5% from PCR positive, 7.7% in total) gave an additional benefit to the patient since only the PCR result was positive. Many of these 62 positive specimens were strongly positive based on crossingpoint values (54% < Cp 30), and these 62 positive clinical specimens were diagnosed as medically relevant as well. Thirty-eight (4.2%) clinical specimens were culture-positive (25 of them were only enrichment culture positive) but PCR-negative, mainly for S. epidermidis, S. aureus and C. acnes. The turnaround times for negative specimens were 4 hours (automated DNA extraction and real time PCR) and 1 working day for positive specimens (including Sanger sequencing). Melting-curve analysis of SYBR Green-PCR enables the differentiation of specific and unspecific PCR products. Using Ripseq, even mixed infections of 2 bacterial species could be resolved. Conclusions For endocarditis cases, the added benefit of PCR is obvious. The crucial innovations of the technology enable timely reporting of explicit reliable results for adequate treatment of patients. Clinical specimens with truly PCR-positive but culture-negative results represent an additional benefit for patients. Very few results at the detection limit still have to be critically examined.
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Affiliation(s)
| | | | - Lorenz Risch
- Dr Risch, 3097, Liebefeld, Switzerland.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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Anton-Vazquez V, Dworakowski R, Cannata A, Amin-Youssef G, Gunning M, Papachristidis A, MacCarthy P, Baghai M, Deshpande R, Khan H, Byrne J, Fife A. 16S rDNA PCR for the aetiological diagnosis of culture-negative infective endocarditis. Infection 2021; 50:243-249. [PMID: 34490592 DOI: 10.1007/s15010-021-01690-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Culture-negative infective endocarditis (IE) accounts for 7-31% of all cases. Metagenomics has contributed to improving the aetiological diagnosis of IE patients undergoing valve surgery. We assessed the impact of 16S ribosomal DNA gene polymerase chain reaction (16S rDNA PCR) in the aetiological diagnosis of culture-negative IE. METHODS Between January 2016 and January 2020, clinical data from culture-negative IE patients were reviewed retrospectively. Identification of bacteria was performed using 16S rDNA PCR in heart valve specimens. RESULTS 36 out of 313 patients (12%) with culture-negative IE had their valve tissue specimens submitted for 16S rDNA PCR. 16S rDNA PCR detected and identified bacterial nucleic acid in heart valve tissue significantly more frequently compared to valve culture alone 25(70%) vs 5(12%); p < 0.05. Mean age was 57 years (SD 18) and 80% were male. Native and aortic valve were involved in 76% and 52% of cases, respectively. Streptococcus spp. (n 15) were the most commonly detected organisms, followed by bacteria of the HACEK group (Haemophilus parainfluenzae 2, Aggregatibacter actinomycetemcomitans 1), nutritionally variant streptococci (Abiotrophia defectiva 2), and one each of Staphylococcus aureus, Corynebacterium pseudodiphtheriticum, Helcococcus kunzii, Neisseria gonorrhoeae, Tropheryma whipplei. CONCLUSION 16S rDNA PCR may be a useful diagnostic tool for the identification of the causative organism in culture-negative IE. Efforts towards a shorter turnaround time for results should be consider and further studies assessing the clinical impact of this technique in culture-negative IE are needed.
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Affiliation(s)
- Vanesa Anton-Vazquez
- Department of Medical Microbiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Antonio Cannata
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - George Amin-Youssef
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Margaret Gunning
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Alexandros Papachristidis
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Phil MacCarthy
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Max Baghai
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Ranjit Deshpande
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Habib Khan
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Jonathan Byrne
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Amanda Fife
- Department of Medical Microbiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
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Rodríguez-García R, Rodríguez-Esteban MÁ, Fernández-Suárez J, Morilla A, García-Carús E, Telenti M, Morales C, Albaiceta GM, Fernández J. Evaluation of 16S rDNA Heart Tissue PCR as a Complement to Blood Cultures for the Routine Etiological Diagnosis of Infective Endocarditis. Diagnostics (Basel) 2021; 11:1372. [PMID: 34441306 PMCID: PMC8394467 DOI: 10.3390/diagnostics11081372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/18/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Identification of the causative pathogen is required to optimize the effective therapy in infective endocarditis (IE). The aim of this study was to assess a 16S rDNA PCR to identify bacteria from heart valve tissues and to evaluate its usefulness as a complement to blood and removed valves cultures. A total of 266 patients diagnosed with IE from January 2015 to December 2019 were evaluated. Results between 16S rDNA PCR from heart valve tissues were compared with microbiological cultures. Blood cultures were positive in 83.5% of patients diagnosed with IE, while 39.6% and 71.8% of the evaluated heart valve samples were positive by culture and 16S rDNA PCR, respectively. For 32 (12%) patients, 16S rDNA tissue PCR provided valuable information supporting the results of blood cultures in the case of bacteria characteristic from the skin microbiota. Additionally, a microorganism was identified by using 16S rDNA PCR in 36% of blood culture-negative cases. The present study reveals that molecular diagnosis using 16S rDNA tissue PCR provides complementary information for the diagnosis of IE, and it should be recommended in surgical endocarditis, especially when blood cultures are negative.
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Affiliation(s)
- Raquel Rodríguez-García
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.R.-G.); (M.Á.R.-E.); (G.M.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - María Ángeles Rodríguez-Esteban
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.R.-G.); (M.Á.R.-E.); (G.M.A.)
| | - Jonathan Fernández-Suárez
- Servicio de Microbiología Clínica, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.F.-S.); (A.M.); (M.T.)
| | - Ana Morilla
- Servicio de Microbiología Clínica, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.F.-S.); (A.M.); (M.T.)
| | - Enrique García-Carús
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Mauricio Telenti
- Servicio de Microbiología Clínica, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.F.-S.); (A.M.); (M.T.)
| | - Carlos Morales
- Servicio de Cirugía Cardiaca, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Guillermo Muñiz Albaiceta
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.R.-G.); (M.Á.R.-E.); (G.M.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, 33003 Oviedo, Spain
| | - Javier Fernández
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Servicio de Microbiología Clínica, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (J.F.-S.); (A.M.); (M.T.)
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