Diagnostic Benefit of Molecular Imaging in Patients Undergoing Heart Valve Surgery for Infective Endocarditis

Author:

Greve Dustin12ORCID,Sartori Emma12,Rodriguez Cetina Biefer Hector345ORCID,Sima Stefania-Teodora126ORCID,Von Schöning Dinah7,Pfäfflin Frieder8ORCID,Stegemann Miriam Songa8ORCID,Falk Volkmar12910,Moter Annette111213ORCID,Kikhney Judith1113,Grubitzsch Herko12ORCID

Affiliation:

1. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany

2. Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany

3. Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland

4. Department of Cardiac Surgery, City Hospital of Zurich, 8063 Zurich, Switzerland

5. Center for Translational and Experimental Cardiology, University of Zurich, 8091 Zurich, Switzerland

6. Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany

7. Department of Microbiology, Labor Berlin—Charité Vivantes GmbH, 13353 Berlin, Germany

8. Department for Infectious Diseases and Critical Care Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany

9. Partner Site Berlin, DZHK (German Centre for Cardiovascular Research), 13125 Berlin, Germany

10. Department of Health Science and Technology, Swiss Federal Institute of Technology, 8093 Zurich, Switzerland

11. Biofilmcenter, Infectious Diseases and Immunology, Institute of Microbiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany

12. Moter Diagnostics, 12207 Berlin, Germany

13. MoKi Analytics GmbH, 12207 Berlin, Germany

Abstract

(1) Background: The successful treatment of infective endocarditis (IE) relies on detecting causative pathogens to administer targeted antibiotic therapy. In addition to standard microbiological cultivation of pathogens from tissue obtained during heart valve surgery, the potential of molecular biological methods was evaluated. (2) Methods: A retrospective study was performed on heart valve tissue from 207 patients who underwent heart valve surgery for IE. FISHseq (fluorescence in situ hybridization combined with 16S rRNA gene PCR and sequencing) was performed in addition to conventional culture-based microbiological diagnostics. The diagnostic performance of FISHseq was compared with the conventional methods and evaluated in the clinical context. (3) Results: Overall, FISHseq provided a significantly higher rate of specific pathogen detection than conventional valve culture (68.1% vs. 33.3%, p < 0.001). By complementing the findings from blood culture and valve culture, FISHseq was able to provide a new microbiological diagnosis in 10% of cases, confirm the cultural findings in 24.2% of cases and provide greater diagnostic accuracy in 27.5% of cases. FISHseq could identify a pathogen in blood-culture-negative IE in 46.2% of cases, while valve culture provided only 13.5% positive results (p < 0.001). (4) Conclusions: This study demonstrates that using FISHseq as an additional molecular biological technique for diagnostics in IE adds substantial diagnostic value, with potential implications for the treatment of IE. It provides pathogen detection, especially in cases where conventional microbiological cultivation is negative or inconclusive.

Publisher

MDPI AG

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