Shrestha Nabin K, Ledtke Christopher S, Wang Hannah, Fraser Thomas G, Rehm Susan J, Hussain Syed T, Pettersson Gosta B, Blackstone Eugene H, Gordon Steven M
Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio; Department of Clinical Pathology, Cleveland Clinic, Cleveland, Ohio.
Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio.
Ann Thorac Surg. 2015 Jan;99(1):33-7. doi: 10.1016/j.athoracsur.2014.07.028. Epub 2014 Oct 22.
Testing excised valves in surgically treated infective endocarditis (IE) patients provides an opportunity to identify the microbial etiology of IE. Microbial sequencing (universal bacterial, mycobacterial, or fungal polymerase chain reaction followed by DNA sequencing) of valves can identify microorganisms accurately, but the value it adds beyond information provided by blood and valve cultures has not been adequately explored.
Three hundred fifty-six patients who underwent surgery for active IE from January 1, 2010, to January 1, 2013, were identified from our cardiovascular information registry and outpatient parenteral antibiotic therapy registry. Their records were reviewed to identify 174 patients whose valves were sent for sequencing. The microbial etiology of IE was defined using comprehensive clinical, pathologic, and microbiological criteria. Blood culture, valve culture, and valve sequencing were examined to determine how frequently they identified the definitive cause of IE.
Of the 174 patients, 162 (93%) had acute inflammation on histopathologic examination of their valves. Valve sequencing was significantly more sensitive than valve culture in identifying the causative pathogen (90% versus 31%, p < 0.001), and yielded fewer false positive results (3% versus 33%, p <0.001). The pathogen would not have been identified in 25 patients (15%) had it not been for valve sequencing. All the value provided by sequencing was attributable to bacterial DNA sequencing; mycobacterial and fungal sequencing provided no additional information beyond that provided by blood culture, histopathology, and valve culture.
Valve sequencing, not valve culture, should be considered the primary test for identifying bacteria in excised cardiac valves.
对接受手术治疗的感染性心内膜炎（IE）患者切除的瓣膜进行检测，为确定IE的微生物病因提供了机会。瓣膜的微生物测序（通用细菌、分枝杆菌或真菌聚合酶链反应后进行DNA测序）可以准确识别微生物，但它所提供的价值超出血液和瓣膜培养所提供信息的程度尚未得到充分研究。
从我们的心血管信息登记处和门诊胃肠外抗生素治疗登记处识别出2010年1月1日至2013年1月1日期间因活动性IE接受手术的356例患者。对他们的记录进行审查，以确定174例其瓣膜被送去测序的患者。使用综合临床、病理和微生物学标准来定义IE的微生物病因。检查血培养、瓣膜培养和瓣膜测序，以确定它们确定IE明确病因的频率。
在这174例患者中，162例（93%）在瓣膜组织病理学检查中有急性炎症。在识别致病病原体方面，瓣膜测序比瓣膜培养显著更敏感（90%对31%，p<0.001），且产生的假阳性结果更少（3%对33%，p<0.001）。若没有瓣膜测序，25例患者（15%）的病原体将无法被识别。测序所提供的所有价值都归因于细菌DNA测序；分枝杆菌和真菌测序除了血培养、组织病理学和瓣膜培养所提供的信息外，没有提供额外信息。
对于识别切除的心脏瓣膜中的细菌，应考虑将瓣膜测序而非瓣膜培养作为主要检测方法。
