Added diagnostic value and impact on antimicrobial therapy of 16S rRNA PCR and amplicon sequencing on resected heart valves in infective endocarditis: a prospective cohort study

Peeters, Bart; Herijgers, Paul; Beuselinck, Kurt; Verhaegen, Jan; Peetermans, Willy; Herregods, Marie‐Christine; Desmet, Stefanie; Lagrou, Katrien

doi:10.1016/j.cmi.2017.06.008

Cited by 23 publications

(20 citation statements)

References 16 publications

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“…Effect of pre-operative antibiotic treatment on valve cultures is controversial, as two studies found no effect [6, 11], but two reported a negative effect [7, 9]. In our material, we had no positive valve cultures after 2 weeks of antimicrobial treatment.…”

Section: Discussionmentioning

confidence: 57%

“…In a study by Peeters et al most (19/24) patients had a causative agent detected with 16S rRNA PCR even after 21 days of antibiotic therapy [6] and another study could not confirm any correlation between the length of pre-operative antibiotic treatment and positive PCR results [9]. Rovery et al demonstrated that bacterial DNA may persist in heart valves for a long time after successful treatment and does not necessarily represent viable organisms [8].…”

Section: Discussionmentioning

confidence: 99%

“…In blood-culture negative cases, etiology may be revealed by serological testing (e.g., Bartonella quintana or Coxiella burnetii antibody assay) or, in patients undergoing valve surgery, by microbiological and molecular testing done on resected heart valves [3, 4]. Of molecular methods, broad range PCR has proven to be a useful diagnostic tool and more sensitive than valve culture [5, 6]. However, the effect of antimicrobial treatment duration on diagnostic yield of valve culture or PCR has not been characterized [6–11].…”

Section: Introductionmentioning

confidence: 99%

“…Of molecular methods, broad range PCR has proven to be a useful diagnostic tool and more sensitive than valve culture [5, 6]. However, the effect of antimicrobial treatment duration on diagnostic yield of valve culture or PCR has not been characterized [6–11].…”

Section: Introductionmentioning

confidence: 99%

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Impact of pre-operative antimicrobial treatment on microbiological findings from endocardial specimens in infective endocarditis

Halavaara

Martelius

Järvinen

et al. 2019

Eur J Clin Microbiol Infect Dis

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Treatment of infective endocarditis (IE) should be initiated promptly. This might hamper the chances to identify the causative organism in blood cultures. Microbiological sampling of infected valve in patients undergoing surgery might identify the causative organism. The impact of pre-operative antimicrobial treatment on the yield of valve samples is not known. This study evaluated the impact of the duration of the pre-operative antibiotic treatment on valve culture and 16S rRNA PCR findings from resected endocardial samples. Patients meeting the modified Duke criteria of definite or possible IE and undergoing valve surgery due to IE during 2011–2016 were included from Southern Finland. Eighty-seven patients were included. In patients with shorter than 2 weeks of pre-operative antimicrobial treatment, PCR was positive in 91% ( n = 42/46) and valve culture in 41% ( n = 19/46) of cases. However, in patients who had 2 weeks or longer therapy before operation, PCR was positive in 53% ( n = 18/34) and all valve cultures were negative. In 14% of patients, PCR had a diagnostic impact. In blood-culture negative cases ( n = 13), PCR could detect the causative organism in ten patients (77%). These included five cases of Bartonella quintana , one Tropheryma whipplei , and one Coxiella burnetii . Long pre-operative antimicrobial treatment was shown to have a negative impact on microbiological tests done on resected endocardial material. After 2 weeks of therapy, all valve cultures were negative, but PCR was positive in half of the cases. PCR aided in diagnostic work-up, especially in blood culture negative cases. Electronic supplementary material The online version of this article (10.1007/s10096-018-03451-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of pre-operative antimicrobial treatment on microbiological findings from endocardial specimens in infective endocarditis

Halavaara

Martelius

Järvinen

et al. 2019

Eur J Clin Microbiol Infect Dis

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“…Up to 30% of samples from these patients are culture-negative, mostly due to the presence of atypical microorganisms and/or antimicrobial use [19]. Peeters et al found that the sensitivity of 16S rRNA PCR (87%) was much higher than that of valve culture (26%) and suggested that the molecular approach was particularly useful for patients with culture-negative infective endocarditis [24]. In our study group, especially for patient 116, 16S rRNA PCR was the most important diagnostic tool for B. quintana, an agent of culture-negative infective endocarditis.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of direct 16S rRNA PCR from clinical samples for bacterial detection in normally sterile body sites

Satilmis

Toprak

Ilgın

et al. 2019

J Infect Dev Ctries

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Introduction: In addition to antibiotic treatment, slow-growing and non-cultivable bacteria can lead to false-negative results for sterile body site infections. In this study, we investigated the efficacy of 16S rRNA polymerase chain reaction (PCR) for such infections. Methodology: Following routine culture procedures, 16S ribosomal RNA (16S rRNA) PCR was performed for samples collected from sterile body sites between July 2017and September 2018. The samples were separated into two groups for likely (group 1) and unlikely infections (group 2) based on clinical and laboratory findings, as well as clinician opinion. Sequence analysis was performed for PCR-positive samples using 16S rRNA primers. Mixed chromatograms were analyzed with the RipSeq Mixed program, and Stata 15.1 was used for statistical analysis. Results: Eighty-seven of 139 samples collected from 116 patients were placed in group 1, and 52 were placed in group 2. Compared with culture as the reference method, the sensitivity, specificity, positive predictive value, and negative predictive value for 16S rRNA PCR were 89.8%, 85.6%, 77.2%, and 93.9%, respectively. 16S rRNA PCR identified infections in 13 culture-negative samples. Among these, three had Bartonella quintana, Mycoplasma salivarium, and Mycobacterium avium complex infections, which cannot be detected with commercial multiplex PCR kits. Conclusions: Our study demonstrates that 16S rRNA PCR is effective for the diagnosis of sterile body site infections, especially for cases of meningitis and infective endocarditis where routine cultures fail.

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The diagnostic benefit of 16S rDNA PCR examination of infective endocarditis heart valves: a cohort study of 146 surgical cases confirmed by histopathology

et al. 2020

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Aims Upon suspicion of infective endocarditis, the causative microorganism must be identified to optimize treatment. Blood cultures and culturing of removed valves are the mainstay of this diagnosis and should be complemented by growth-independent methods. We assessed the diagnostic benefit of examining removed endocarditis valves by broad-range bacterial PCR to detect causative bacteria in cases where culturing was not available, negative, or inconclusive because a skin commensal was detected, in patients from our clinical routine practice. Methods and results Patients from Heidelberg University Hospital with suspicion of endocarditis, followed by valve replacement and analysis by 16S rDNA PCR, between 2015 and 2018, were evaluated. 146 patients with definite infective endocarditis, confirmed by the valve macroscopics and/or histology, were included. Valve PCRs were compared to corresponding blood and valve culture results. Overall, valve PCR yielded an additional diagnostic benefit in 34 of 146 cases (23%) and was found to be more sensitive than valve culture. In 19 of 38 patients with both negative blood and valve cultures, valve PCR was the only method rendering a pathogen. In 23 patients with positive blood cultures detecting skin commensals, 4 patients showed discordant valve PCR results, detecting a more plausible pathogen, and in 11 of 23 cases, valve PCR confirmed commensals in blood culture as true pathogens. Only the remaining 8 patients had negative valve PCRs. Conclusion Valve PCR was found to be a valuable diagnostic tool in surgical endocarditis cases with negative blood cultures or positive blood cultures of unknown significance. Trial registration S-440/2017 on 28.08.2017 retrospectively registered. Graphic abstract Subdividing of all infective endocarditis patients in this study, showing that valve PCR yields valuable information for patients with skin commensals in blood cultures, which were either confirmed by the same detection in valve PCR or refuted by the detection of a different and typical pathogen in valve PCR. Additionally, benefit was determined in patients with negative or not available blood cultures and only positive detection in valve PCR. +: Positive; −: negative; n/a: not available results

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Added diagnostic value and impact on antimicrobial therapy of 16S rRNA PCR and amplicon sequencing on resected heart valves in infective endocarditis: a prospective cohort study

Abstract: The very good performance characteristics, added diagnostic value and impact on antimicrobial therapy of molecular testing of heart valves should support the incorporation of molecular testing in diagnostic criteria and guidelines for IE.

Cited by 23 publications

References 16 publications

Impact of pre-operative antimicrobial treatment on microbiological findings from endocardial specimens in infective endocarditis

Impact of pre-operative antimicrobial treatment on microbiological findings from endocardial specimens in infective endocarditis

Evaluation of direct 16S rRNA PCR from clinical samples for bacterial detection in normally sterile body sites

The diagnostic benefit of 16S rDNA PCR examination of infective endocarditis heart valves: a cohort study of 146 surgical cases confirmed by histopathology

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