Molecular Approach to Diagnosis of Cardiovascular Implantable Electronic Device Infection

• Published in: Clinical infectious diseases Vol. 70; no. 5; pp. 898 - 906
• Main Authors: Esquer Garrigos, Zerelda, Sohail, M Rizwan, Greenwood-Quaintance, Kerryl E, Cunningham, Scott A, Vijayvargiya, Prakhar, Fida, Madiha, Friedman, Paul A, Mandrekar, Jayawant, DeSimone, Daniel C, Baddour, Larry M, Patel, Robin
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 14.02.2020
• Subjects: and Commentaries; Bacteria - genetics; DNA, Bacterial - genetics; Electronics; Humans; Polymerase Chain Reaction; Prostheses and Implants; RNA, Ribosomal, 16S - genetics; Sensitivity and Specificity; 16S rRNA PCR/sequencing; laboratory diagnosis; cardiovascular implantable electronic device infection
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciz266

Abstract Background Sonicate fluid (SF), a solution derived from vortexing and sonication of explanted cardiovascular implantable electronic devices (CIEDs), is a higher-yield specimen compared with swabs or tissues for culture-based detection of microorganisms associated with CIED infection. Despite this, SF culture fails to identify a causative organism in ~50% of cases. We aimed to evaluate the diagnostic performance of 16S ribosomal RNA gene (rRNA) polymerase chain reaction (PCR)/sequencing of SF and compare it with that of SF culture. Methods We identified 322 SF specimens from extracted CIEDs and reviewed clinical data for each patient. Subjects were classified as having or not having CIED infection. Cases were subcategorized as culture negative if no significant growth was reported from SF cultures and as culture positive if an organism was detected above predefined thresholds. 16S rRNA PCR/sequencing was performed, with the organisms identified reported according to Clinical and Laboratory Standards Institute guidelines for sequence data interpretation. Results A total of 278 SF samples corresponded to infected cases, of which 160 were culture positive and 118 culture negative. The remaining 44 were from noninfected cases, of which 2 were culture positive. Compared with SF culture, the sensitivity of 16S rRNA PCR/sequencing was higher (64% vs 57.5%, P = .003). 16S rRNA PCR/sequencing detected a potential pathogen in 28 of 118 culture-negative cases, identifying staphylococci in the majority (18/28). Conclusions 16S rRNA PCR/sequencing has higher sensitivity to detect bacteria in SF from extracted CIEDs than does SF culture. We demonstrate that 16S rRNA PCR/sequencing has higher sensitivity to detect bacteria in sonicate fluid (SF) from extracted cardiovascular implantable electronic devices than SF culture; therefore this method should be considered for clinical application, especially in cases with negative cultures.