The diagnosis of microorganism involved in infective endocarditis (IE) by polymerase chain reaction (PCR) and real‐time PCR: A systematic review

Abstract

Broad-range bacterial rDNA polymerase chain reaction (PCR) followed by sequencing may be identified as the etiology of infective endocarditis (IE) from surgically removed valve tissue; therefore, we reviewed the value of molecular testing in identifying organisms' DNA in the studies conducted until 2016. We searched Google Scholar, Scopus, ScienceDirect, Cochrane, PubMed, and Medline electronic databases without any time limitations up to December 2016 for English studies reporting microorganisms involved in infective endocarditis microbiology using PCR and real-time PCR. Most studies were prospective. Eleven out of 12 studies used valve tissue samples and blood cultures while only 1 study used whole blood. Also, 10 studies used the molecular method of PCR while 2 studies used real-time PCR. Most studies used 16S rDNA gene as the target gene. The bacteria were identified as the most common microorganisms involved in infective endocarditis. Streptococcus spp. and Staphylococcus spp. were, by far, the most predominant bacteria detected. In all studies, PCR and real-time PCR identified more pathogens than blood and tissue cultures; moreover, the sensitivity and specificity of PCR and real-time PCR were more than cultures in most of the studies. The highest sensitivity and specificity were 96% and 100%, respectively. The gram positive bacteria were the most frequent cause of infective endocarditis. The molecular methods enjoy a greater sensitivity compared to the conventional blood culture methods; yet, they are applicable only to the valve tissue of the patients undergoing cardiac valve surgery.

Microbial Identification Using DNA Target Amplification and Sequencing: Clinical Utility and Impact on Patient Management

“…This study is 1 of the first to examine the performance and clinical impact of broad-range PCR in real-world clinical practice, in a setting where most patients had negative cultures [ 10 , 11 , 28 ]. Previous studies have demonstrated the ability of broad-range PCR to identify organisms from heart valve tissue [ 11 , 14–16 ], joint tissue [ 12 ], and other sterile sites, with sensitivity and specificity ranging from 43% to 96% and 72% to 95%, respectively. However, these studies typically compared PCR results with standard culture results as a gold standard.…”

“…In 1 large study using 16S rRNA PCR, Rampini et al demonstrated 91% concordance with bacterial cultures in 394 culture-positive samples and were able to identify 24 bacteria among 184 culture-negative samples [ 10 ]. 16S rRNA PCR is also increasingly being used as part of the diagnostic evaluation of prosthetic joint infection [ 11–13 ] and culture-negative endocarditis [ 11 , 14–16 ].…”

Streptobacillus moniliformis Mitral Valve Endocarditis and Septic Arthritis: The Challenges of Diagnosing Rat-Bite Fever Endocarditis

“… 3 In comparison to blood cultures, PCR can increase the sensitivity while decreasing the time to obtain results, which can take up to 7 days using standard techniques, although being significantly more expensive. 18 Given the large sequence database of bacteria available from GenBank, the 16S rRNA is the favored target gene for the identification of fastidious organisms. Tak et al compared blood culture with PCR-based methods in patients with definitive or possible endocarditis and showed that PCR almost always identified a bacterium, even when the blood cultures were negative.…”

Bio-barcode detection technology and its research applications: A review

“…As a standard technique for nucleic acid detection, PCR technology is a highly sensitive method for amplifying specific DNA fragments. However, it relies on enzymatic amplification, requires expensive reagents and is time-consuming [71] , [72] , [73] , [74] , [75] , [76] , [77] . On the other hand, compared to PCR, BCA technology has achieves high sensitivity, and simple detection while being less time consuming and labour intensive.…”