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
- Authors: Kotova E.O.1,2, Domonova E.A.3, Kobalava Z.D.1,2, Moiseeva A.Y.1, Pisaryuk A.S.1,2, Silveystrova O.Y.3, Karaulova J.L.1,2, Akimkin V.G.3
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Affiliations:
- People’s Friendship University of Russia (RUDN University)
- Vinogradov City Clinical Hospital
- Central Research Institute of Epidemiology
- Issue: Vol 95, No 1 (2023)
- Pages: 23-31
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/133007
- DOI: https://doi.org/10.26442/00403660.2023.01.202042
- ID: 133007
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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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##article.viewOnOriginalSite##About the authors
Elizaveta O. Kotova
People’s Friendship University of Russia (RUDN University); Vinogradov City Clinical Hospital
Author for correspondence.
Email: mauschen@inbox.ru
ORCID iD: 0000-0002-9643-5089
канд. мед. наук, доц. каф. внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева Медицинского института
Russian Federation, Moscow; MoscowElvira A. Domonova
Central Research Institute of Epidemiology
Email: mauschen@inbox.ru
ORCID iD: 0000-0001-8262-3938
канд. биол. наук, рук. научной группы разработки новых методов диагностики оппортунистических и папилломавирусных инфекций отд. молекулярной диагностики и эпидемиологии
Russian Federation, MoscowZhanna D. Kobalava
People’s Friendship University of Russia (RUDN University); Vinogradov City Clinical Hospital
Email: mauschen@inbox.ru
ORCID iD: 0000-0002-5873-1768
чл.-кор. РАН, д-р мед. наук, проф., зав. каф. внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева Медицинского института
Russian Federation, Moscow; MoscowAleksandra Yu. Moiseeva
People’s Friendship University of Russia (RUDN University)
Email: mauschen@inbox.ru
ORCID iD: 0000-0003-0718-5258
аспирант 2-го года каф. внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева Медицинского института
Russian Federation, MoscowAlexandra S. Pisaryuk
People’s Friendship University of Russia (RUDN University); Vinogradov City Clinical Hospital
Email: mauschen@inbox.ru
ORCID iD: 0000-0003-4103-4322
канд. мед. наук, доц. каф. внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева Медицинского института; врач-кардиолог отд-ния реанимации и интенсивной терапии
Russian Federation, Moscow; MoscowOlga Yu. Silveystrova
Central Research Institute of Epidemiology
Email: mauschen@inbox.ru
ORCID iD: 0000-0001-8412-9765
науч. сотр. научной группы разработки новых методов диагностики оппортунистических и папилломавирусных инфекций отд. молекулярной диагностики и эпидемиологии
Russian Federation, MoscowJulia L. Karaulova
People’s Friendship University of Russia (RUDN University); Vinogradov City Clinical Hospital
Email: mauschen@inbox.ru
ORCID iD: 0000-0003-4799-2740
д-р мед. наук, доц., проф. каф. внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева Медицинского института
Russian Federation, Moscow; MoscowVasiliy G. Akimkin
Central Research Institute of Epidemiology
Email: mauschen@inbox.ru
ORCID iD: 0000-0003-4228-9044
акад. РАН, д-р мед. наук, проф., дир.
Russian Federation, MoscowReferences
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