Antibiotic therapy following polymerase chain reaction diagnosis of infective endocarditis: a single centre experience

Marsch, Georg; Orszag, Peter; Mashaqi, Bakr; Kuehn, C.; Haverich, Axel

doi:10.1093/icvts/ivv006

Cited by 25 publications

(18 citation statements)

References 17 publications

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“…Only for valve culture was a significantly lower sensitivity observed (18%), which is in accordance with many publications (8,(10)(11)(12). Specificity ranged from 83% to 100% for all test modalities, but the number of nonendocarditis samples is certainly too low in this study to evaluate specificity.…”

Section: Discussionsupporting

confidence: 89%

“…Broad-range PCR, targeting the 16S rRNA gene, followed by subsequent sequencing of the amplicon proved to be superior to the culture of excised valves (VC) (8,(10)(11)(12). The sensitivity and specificity of 16S rRNA PCR for detecting the causative microorganism ranged from 61% to 90% and 97% to 100%, respectively, whereas the sensitivity and specificity of VC ranged from 23% to 31% and 67% to 87%, respectively (10)(11)(12). The use of different or no criteria for defining the definite microbiological cause of IE complicates the diagnostic comparison of different tests.…”

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confidence: 99%

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Comparison of PCR-Electrospray Ionization Mass Spectrometry with 16S rRNA PCR and Amplicon Sequencing for Detection of Bacteria in Excised Heart Valves

et al. 2016

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f Identification of the causative pathogen of infective endocarditis (IE) is crucial for adequate management and therapy. A broadrange PCR-electrospray ionization mass spectrometry (PCR-ESI-MS) technique was compared with broad-spectrum 16S rRNA PCR and amplicon sequencing (16S rRNA PCR) for the detection of bacterial pathogens in 40 heart valves obtained from 34 definite infective endocarditis patients according to the modified Duke criteria and six nonendocarditis patients. Concordance between the two molecular techniques was 98% for being positive or negative, 97% for concordant identification up to the genus level, and 77% for concordant identification up to the species level. Sensitivity for detecting the causative pathogen (up to the genus level) in excised heart valves was 88% for 16S rRNA PCR and 85% for PCR-ESI-MS; the specificity was 83% for both methods. The two molecular techniques were significantly more sensitive than valve culture (18%) and accurately identified bacteria in excised heart valves. In eight patients with culture-negative IE, the following results were obtained: concordant detection of Coxiella burnetii (n ‫؍‬ 2), Streptococcus gallolyticus (n ‫؍‬ 1), Propionibacterium acnes (n ‫؍‬ 1), and viridans group streptococci (n ‫؍‬ 1) by both molecular tests, detection of P. acnes by PCR-ESI-MS whereas the 16S rRNA PCR was negative (n ‫؍‬ 1), and a false-negative result by both molecular techniques (n ‫؍‬ 2). In one case of IE caused by viridans streptococci, PCR-ESI-MS was positive for Enterococcus spp. The advantages of PCR-ESI-MS compared to 16S rRNA PCR are its automated workflow and shorter turnaround times. Diagnosis of infective endocarditis (IE) remains challenging. A multidisciplinary approach by microbiologists, infectiologists, surgeons, and cardiologists is needed for adequate management. Identification of the pathogen is crucial for selecting appropriate antimicrobial therapy (1-4). According to the modified Duke criteria, positive blood cultures (BCs) remain the cornerstone of the microbiological diagnosis of IE (4). Three sets of BCs, taken before starting antimicrobial therapy, detect 96% to 98% of bacteremia (5, 6). Unfortunately, BCs are negative in 2% to 31% of IE patients due to prior antimicrobial therapy or fastidious (Brucella spp., fungi) or intracellular (Coxiella burnetii, Bartonella spp., or Tropheryma whipplei) microorganisms, resulting in obscured diagnoses (7-9). During the last decade, molecular techniques performed directly on excised heart valves have emerged. Broad-range PCR, targeting the 16S rRNA gene, followed by subsequent sequencing of the amplicon proved to be superior to the culture of excised valves (VC) (8, 10-12). The sensitivity and specificity of 16S rRNA PCR for detecting the causative microorganism ranged from 61% to 90% and 97% to 100%, respectively, whereas the sensitivity and specificity of VC ranged from 23% to 31% and 67% to 87%, respectively (10-12). The use of different or no criteria for defining the definite microbiological cause of IE ...

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Section: Discussionsupporting

confidence: 89%

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confidence: 99%

Comparison of PCR-Electrospray Ionization Mass Spectrometry with 16S rRNA PCR and Amplicon Sequencing for Detection of Bacteria in Excised Heart Valves

et al. 2016

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“…A recent study by Miller et al included 50 patients with definite IE and 16S rRNA PCR had therapeutic impact in four (8%) of them [5]. Marsch et al included 46 cases of culture-negative IE and in seven (15%) patients, antibiotic therapy was adjusted according to 16S rRNA PCR results from excised heart valves [7]. Our study included 127 patients and in 12 (10%) of them molecular results influenced antimicrobial therapy.…”

Section: Discussionmentioning

confidence: 85%

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

Herijgers

Beuselinck

et al. 2017

Clinical Microbiology and Infection

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“…Although broad-range bacterial PCR has been applied to blood sources, sensitivity is superior when performed on excised valve tissue, with an organism detected in 66% (150/227) of endocarditis cases in one study compared to just 14% (35/257) of cases when performed on EDTA blood (7). Broad-range bacterial PCR performed on valve tissue has a reported sensitivity of 33% to 90%, while sensitivity of valve culture in the same studies was 8% to 33% (7,(27)(28)(29)(30)(31). Differing patient populations and assay designs likely account for variations in sensitivities between studies.…”

Section: Evaluation Of Excised Cardiac Valvular Tissuementioning

confidence: 96%

Laboratory Diagnosis of Infective Endocarditis

et al. 2017

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Infective endocarditis is life-threatening; identification of the underlying etiology informs optimized individual patient management. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing (i.e., Q fever serology, Bartonella serology) in culture-negative cases. Histopathology and molecular diagnostics (e.g., 16S rRNA gene PCR/sequencing, Tropheryma whipplei PCR) may be applied to resected valves to aid in diagnosis. Herein, we summarize recent knowledge in this area and propose a microbiologic and pathological algorithm for endocarditis diagnosis. KEYWORDS clinical microbiology, endocarditisD espite recent advances in diagnostic and therapeutic strategies, the mortality of infective endocarditis remains high, with more than one-third of patients affected dying within a year following diagnosis (1, 2). Identification of the specific underlying microbial etiology is essential for optimal patient management; delays in microbial diagnosis may contribute to late initiation of effective antimicrobial therapy, influencing morbidity and mortality. The modified Duke criteria provide a basic scheme for diagnosis and definition of endocarditis and rely on detection of infecting microorganisms in addition to echocardiographic and clinical findings (1, 3). The finding of two (or more) blood cultures positive for a typical microorganism consistent with infective endocarditis is a major criterion for infective endocarditis as is positive Q fever serology (anti-phase I IgG titer of Ն1:800). Echocardiographic findings are also considered but are beyond the scope of the manuscript.The epidemiology of endocarditis, which has shifted in recent years, should guide diagnostic testing. Today, staphylococci and streptococci combined cause ϳ80% of cases. Staphylococcus aureus remains the dominant pathogen, associated with ϳ25% to ϳ30% of cases, while coagulase-negative staphylococci account for ϳ11% of cases (4, 5). Streptococci, primarily viridans group streptococci, cause ϳ30% of cases, with Streptococcus gallolyticus (a Streptococcus bovis group member) being involved in ϳ20% to ϳ50% of streptococcal cases (4, 5). Enterococci, especially Enterococcus faecalis, account for ϳ10% of cases (4, 5). Gram-negative bacilli account for ϳ5% of cases and include the HACEK group organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella species) and, less commonly, non-HACEK Gramnegative bacilli, such as the Enterobacteriaceae and nonfermenting Gram-negative bacilli. Fungi are rare endocarditis causes, with Candida species being the most common. A number of uncultivable or challenging to cultivate organisms cause endocarditis, the most common of which are Coxiella burnetii, Bartonella species, and Tropheryma whipplei.Endocarditis most often involves the aortic or mitral valves, with tricuspid valve involvement accoun...

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Antibiotic therapy following polymerase chain reaction diagnosis of infective endocarditis: a single centre experience

Cited by 25 publications

References 17 publications

Comparison of PCR-Electrospray Ionization Mass Spectrometry with 16S rRNA PCR and Amplicon Sequencing for Detection of Bacteria in Excised Heart Valves

Comparison of PCR-Electrospray Ionization Mass Spectrometry with 16S rRNA PCR and Amplicon Sequencing for Detection of Bacteria in Excised Heart Valves

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

Laboratory Diagnosis of Infective Endocarditis

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