Email this article 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
- Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075-128. doi: 10.1093/eurheartj/ehv319
- Демин А.А., Кобалава Ж.Д., Скопин И.И., и др. Инфекционный эндокардит и инфекция внутрисердечных устройств у взрослых. Клинические рекомендации МЗ РФ. Российский кардиологический журнал. 2022;27(10):5233 [Demin AA, Kobalava ZD, Skopin II, et al. Infectious endocarditis and infection of intracardiac devices in adults. Clinical guidelines 2021. Russian Journal of Cardiology. 2022;27(10):5233 (in Russian)]. doi: 10.15829/1560-4071-2022-5233
- Котова Е.О., Домонова Э.А., Кобалава Ж.Д., и др. Современные тренды этиологической диагностики инфекционного эндокардита. Рациональная фармакотерапия в кардиологии. 2021;17(1):153-64 [Kotova EO, Domonova EA, Kobalava ZhD, et al. Modern trends in identification of causative agents in infective endocarditis. Rational Pharmacotherapy in Cardiology. 2021;17(1):153-64 (in Russian)]. doi: 10.20996/1819-6446-2021-02-14
- Liesman RM, Pritt BS, Maleszewski JJ, Patel R. Laboratory diagnosis of infective endocarditis. J Clin Microbiol. 2017;55(9):2599-608. doi: 10.1128/JCM.00635-17
- Fournier PE, Gouriet F, Casalta JP, et al. Blood culture-negative endocarditis. Medicine. 2017;47(96):8392. doi: 10.1097/MD.0000000000008392
- Geissdorfer W, Moos V, Moter A, et al. High frequency of Tropheryma whipplei in culturenegative endocarditis. J Clin Microbiol. 2012;50(2):216-22. doi: 10.1128/JCM.05531-11
- Miller RJ, Chow B, Pillai D, Church D. Development and evaluation of a novel fast broad-range 16S ribosomal DNA PCR and sequencing assay for diagnosis of bacterial infective endocarditis: multi-year experience in a large Canadian healthcare zone and a literature review. BMC Infect Dis. 2016;16:146. doi: 10.1186/s1287 9-016-1476-4
- Котова Е.О., Домонова Э.А., Кобалава Ж.Д., и др. Инфекционный эндокардит неустановленной этиологии: возможности преодоления и роль микробиологистики. Кардиология. 2021;61(1):87-97 [Kotova EO, Domonova EA, Kobalava ZhD, и др. Infective Endocarditis With Unknown Etiology: Possibilities of Conquering and Role of Microbiologistics. Kardiologiia. 2021;61(1):87-97 (in Russian)]. doi: 10.18087/cardio.2021.1.n1218
- Godfrey R, Curtis S, Schilling W, James P. Blood culture negative endocarditis in the modern era of 16S rRNA sequencing. Clin Med. 2020;20(40):412-6. doi: 10.7861/clinmed.2019-0342
- Kuhn C, Disque C, Muhl H, et al. Evaluation of Commercial Universal rRNA Gene PCR plus Sequencing Tests for Identification of Bacteria and Fungi Associated with Infectious Endocarditis. J Clin Microbiol. 2011;8(49):2919-23. doi: 10.1128/JCM.00830-11
- El-Kholy AA, El-Rachidi NG, El-Enany M, et al. Impact of serology and molecular methods on improving the microbiologic diagnosis of infective endocarditis in Egypt. Infection. 2015;43(5):523-9. doi: 10.1007/s15010-015-0761-2
- Habib G, Erba PA, Iung B, et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J. 2019;40(39):3222-32. doi: 10.1093/eurheartj/ehz620
- Домонова Э.А., Творогова М.Г., Подколзин А.Т., и др. Взятие, транспортировка, хранение биологического материала для ПЦР-диагностики: Методические рекомендации. М.: ФБУН ЦНИИ Эпидемиологии Роспотребнадзора, 2021 [Domonova EA, Tvorogova MG, Podkolzin AT, et al. Vziatie, transportirovka, khranenie biologicheskogo materiala dlia PTsR-diagnostiki: Metodicheskie rekomendatsii. Moscow: Central Research Institute of Epidemiology of Rospotrebnadzor, 2021 (in Russian)]. doi: 10.36233/978-5-6045286-6-2
- Armstrong K, Kuhn TC, Dufner M, et al. The diagnostic benefit of 16S rDNA PCR examination of infective endocarditis heart valves: a cohort study of 146 surgical cases confirmed by histopathology. Clin Res Cardiol. 2021;110:332-42. doi: 10.1007/s00392-020-01678-x
- Котова Е.О., Домонова Э.А., Караулова Ю.Л. и др. Инфекционный эндокардит: значение молекулярно-биологических методов в этиологической диагностике. Терапевтический архив. 2016;88(11):62-7 [Kotova EO, Domonova EA, Karaulova YuL, et al. Infective endocarditis: Importance of molecular biology techniques in the etiological diagnosis. Terapevticheskii Arkhiv (Ter. Arkh.). 2016;88(11):62-7 (in Russian)]. doi: 10.17116/terarkh2016881162-67
- Данилов А.И., Алексеева И.В., Аснер Т.В., и др. Реальная практика терапии инфекционного эндокардита в РФ: промежуточные результаты исследования МАЭСТРО. Клиническая микробиология и антимикробная химиотерапия. 2013;15(2):18-9 [Danilov AI, Alekseeva IV, Asner TV, et al. Real practice of therapy for infective endocarditis in the Russian Federation: interim results of the MAESTRO study. Clinical Microbiology and Antimicrobial Chemotherapy. 2013;15(2):18-9 (in Russian)].
- Peeters B, Herijgers P, Beuselinck K, et al. 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. Clin Microbiol Infect. 2017;23(11):888e1-5. doi: 10.1016/j.cmi.2017.06.008
- Halavaara M, Martelius T, Jarvinen A, et al. Impact of pre-operative antimicrobial treatment on microbiological findings from endocardial specimens in infective endocarditis. Eur J Clin Microbiol Infect. 2019;38(3):497-503. doi: 10.1007/s1009 6-018-03451-5
- Kemp M, Bangsborg J, Kjerulf A, et al. Advantages and Limitations of Ribosomal RNA PCR and DNA Sequencing for Identification of Bacteria in Cardiac Valves of Danish Patients. Open Microbiol J. 2013;7:146-51. doi: 10.2174/1874285801307010146
- Bast A, Dohmen PM, Podbielski A, Warnke P. Rapid Microbiological Diagnostics from Explanted Heart Valves by a Multiplex PCR Assay. J Clin Microbiol. 2019;57(2):e01575-18. doi: 10.1128/JCM.01575-18
- Kim MS, Chang J, Kim MN, et al. Utility of a Direct 16S rDNA PCR and Sequencing for Etiological Diagnosis of Infective Endocarditis. Ann Lab Med. 2017;37(6):505-10. doi: 10.3343/alm.2017.37.6.505
- Boujelben I, Gdoura R, Hammami A. A broad-range PCR technique for the diagnosis of infective endocarditis. Braz J Microbiol. 2018;49(3):534-43. doi: 10.1016/j.bjm.2017.03.019
- Voldstedlund M, Pedersen L, Baandrup U, et al. Broad-range PCR and sequencing in routine diagnosis of infective endocarditis. APMIS. 2008;116(3):190-8. doi: 10.1111/j.1600-0463.2008.00942.x
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