Novel Diagnostic Methods for Infective Endocarditis

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.

Exploring Unusual Cardiac Complications: Chorda Tendinea Rupture and Pulmonary Valve Vegetation in Infective Endocarditis—A Comprehensive Review

“…Imaging modalities, notably echocardiography in transthoracic and transesophageal forms, assume pivotal roles in IE diagnosis by facilitating the detection of vegetations, valvular abnormalities, and complications like abscess formation. Emerging as a valuable adjunct to echocardiography, multislice computed tomography (CT) is gaining recognition for its utility in diagnosing IE [ 44 , 45 ]. Challenges in IE research persist despite its significant clinical impact, primarily attributable to deficiencies in research infrastructure and funding.…”

“…Regarding treatment implications, the prompt and accurate diagnosis of IE is imperative for initiating appropriate antibiotic therapy and considering surgical intervention as warranted. Delayed diagnosis can precipitate serious complications and escalate mortality rates [ 44 , 45 ].…”

“…For instance, investigations have highlighted the thrombin inhibitor dabigatran as a promising adjunctive treatment strategy, mainly when administered alongside antibiotic (gentamicin) therapy in vivo, showcasing the potential for improved treatment efficacy [ 54 ]. Future research endeavours in IE should prioritize the development of innovative diagnostic methods, mainly focusing on enhancing the detection of blood culture-negative infective endocarditis (BCNIE) [ 45 ]. Novel approaches such as targeted metagenomics on whole blood and plasma and 16S rRNA gene-targeted next-generation sequencing hold promise for enabling more accurate pathogen identification in IE cases [ 45 ].…”

“…Future research endeavours in IE should prioritize the development of innovative diagnostic methods, mainly focusing on enhancing the detection of blood culture-negative infective endocarditis (BCNIE) [ 45 ]. Novel approaches such as targeted metagenomics on whole blood and plasma and 16S rRNA gene-targeted next-generation sequencing hold promise for enabling more accurate pathogen identification in IE cases [ 45 ]. Recognizing the complexity of IE management, a clinically integrated multidisciplinary approach is advocated, highlighting the significance of collaborative efforts among various medical specialities to ensure comprehensive care for patients with IE [ 55 ].…”