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
Division of Infectious Diseases Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Clin Infect Dis. 2020 Feb 14;70(5):898-906. doi: 10.1093/cid/ciz266.
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.
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.
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).
16S rRNA PCR/sequencing has higher sensitivity to detect bacteria in SF from extracted CIEDs than does SF culture.
超声处理液（SF）是一种通过对取出的心血管植入式电子设备（CIED）进行涡旋和超声处理得到的溶液，与拭子或组织相比，它是用于基于培养检测与CIED感染相关微生物的更高产量标本。尽管如此，SF培养在约50%的病例中未能鉴定出致病微生物。我们旨在评估SF的16S核糖体RNA基因（rRNA）聚合酶链反应（PCR）/测序的诊断性能，并将其与SF培养的诊断性能进行比较。
我们从取出的CIED中鉴定出322份SF标本，并回顾了每位患者的临床数据。将受试者分类为患有或未患有CIED感染。如果SF培养未报告显著生长，则病例被归类为培养阴性；如果检测到的微生物高于预定义阈值，则病例被归类为培养阳性。进行16S rRNA PCR/测序，并根据临床和实验室标准协会的序列数据解释指南报告鉴定出的微生物。
共有278份SF样本对应感染病例，其中160份培养阳性，118份培养阴性。其余44份来自未感染病例，其中2份培养阳性。与SF培养相比，16S rRNA PCR/测序的敏感性更高（64%对57.5%，P = 0.003）。16S rRNA PCR/测序在118份培养阴性病例中的28份中检测到潜在病原体，其中大多数（18/28）为葡萄球菌。
16S rRNA PCR/测序在检测取出的CIED的SF中的细菌方面比SF培养具有更高的敏感性。
