Bosshard Philipp Peter, Kronenberg Andreas, Zbinden Reinhard, Ruef Christian, Böttger Erik Christian, Altwegg Martin
Institute of Medical Microbiology, University of Zurich, Switzerland.
Clin Infect Dis. 2003 Jul 15;37(2):167-72. doi: 10.1086/375592. Epub 2003 Jul 9.
We analyzed surgically resected endocardial specimens from 49 patients by broad-range PCR. PCR results were compared with (1) results of previous blood cultures, (2) results of culture and Gram staining of resected specimens, and (3) clinical data (Duke criteria). Molecular analyses of resected specimens and previous blood cultures showed good overall agreement. However, in 18% of patients with sterile blood cultures, bacterial DNA was found in the resected materials. When data from patients with definite or rejected cases of infective endocarditis (IE) were included, the sensitivity, specificity, and positive and negative predictive values of broad-range PCR were 82.6%, 100%, 100%, and 76.5%, respectively, overall, and 94.1%, 100%, 100%, and 90%, for cases of native valve endocarditis. The sensitivity, specificity, and positive and negative predictive values of culture of resected specimens from patients with native valve endocarditis were 17.6%, 88.9%, 75%, and 36.4%. We recommend broad-range PCR of surgically resected endocardial material in cases of possible IE, in cases of suspected IE in which blood cultures are sterile, and in cases in which organisms grow in blood cultures but only Duke minor criteria are met. We propose to add molecular techniques to the pathologic criteria of the Duke classification scheme.
我们通过广谱聚合酶链反应（PCR）分析了49例患者手术切除的心内膜标本。将PCR结果与以下各项进行比较：（1）先前血培养的结果；（2）切除标本的培养及革兰氏染色结果；（3）临床数据（杜克标准）。对切除标本和先前血培养的分子分析显示总体一致性良好。然而，在血培养无菌的患者中，18%的患者切除材料中发现了细菌DNA。当纳入感染性心内膜炎（IE）确诊或排除病例患者的数据时，总体而言，广谱PCR的敏感性、特异性、阳性预测值和阴性预测值分别为82.6%、100%、100%和76.5%，对于自身瓣膜心内膜炎病例分别为94.1%、100%、100%和90%。自身瓣膜心内膜炎患者切除标本培养的敏感性、特异性、阳性预测值和阴性预测值分别为17.6%、88.9%、75%和36.4%。对于可能的IE病例、血培养无菌的疑似IE病例以及血培养中有微生物生长但仅满足杜克次要标准的病例，我们建议对手术切除的心内膜材料进行广谱PCR检测。我们提议将分子技术纳入杜克分类方案的病理标准中。
