16S rDNA sequencing of valve tissue improves microbiological diagnosis in surgically treated patients with infective endocarditis

• Published in: The Journal of infection Vol. 62; no. 6; pp. 472 - 478
• Main Authors: Vondracek, Martin, Sartipy, Ulrik, Aufwerber, Ewa, Julander, Inger, Lindblom, Dan, Westling, Katarina
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.06.2011; Elsevier
• Subjects: 16S rDNA sequencing; Adult; Aged; Bacteria - classification; Bacteria - genetics; Bacteria - isolation & purification; Bacteriological Techniques - methods; Biological and medical sciences; Blood culture; Blood culture negative endocarditis; Cardiology. Vascular system; DNA, Bacterial - chemistry; DNA, Bacterial - genetics; DNA, Ribosomal - chemistry; DNA, Ribosomal - genetics; Endocardial and cardiac valvular diseases; Endocarditis; Endocarditis - diagnosis; Endocarditis - microbiology; Endocarditis - surgery; Female; General aspects; Heart; Heart Valves - microbiology; Humans; Infectious Disease; Infective endocarditis; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; RNA, Ribosomal, 16S - genetics; rRNA 16S; Sensitivity and Specificity; Sequence Analysis, DNA - methods; Surgery; Sweden; Valvular replacement; Sweden; Infective endocarditis; Valvular replacement; 16S rDNA sequencing; Blood culture negative endocarditis; Human; Infection; Treatment; Nucleotide sequence; Heart disease; Endocardial disease; Ribosomal DNA; Endocarditis; Cardiovascular disease; Diagnosis; Sequencing
• ISSN: 0163-4453; 1532-2742; 1532-2742
• DOI: 10.1016/j.jinf.2011.04.010

Summary Objectives The aim was to evaluate 16S rDNA sequencing in heart valves in patients with infective endocarditis undergoing surgery. Methods Fifty-seven patients with infective endocarditis were examined in this prospective study by analysing heart valves with 16S rDNA sequencing and culturing methods and comparing the results to blood cultures. As controls, heart valves from 61 patients without any signs of endocarditis were examined. Results All together 77% of the endocarditis patients were positive for 16S rDNA, 84% had positive blood cultures and 23% had positive cultures from heart valves, whereas only 16% of the cultures from heart valves were concordant with results from blood cultures or 16S rDNA. Concordant results between 16S rDNA sequencing and blood cultures were found in 75% patients. All controls were negative for 16S rDNA. In 4 out of 9 patients with negative blood cultures, the aetiology was established by 16S rDNA alone, i.e. viridans group streptococci. Conclusion In this Swedish study, 16S rDNA sequencing of valve material was shown to be a valuable addition in blood culture-negative cases. The value of heart valve culture was low. Molecular diagnosis using 16S rDNA sequencing should be recommended in patients undergoing valve replacement for infective endocarditis.