Haddad Sara F, DeSimone Daniel C, Chesdachai Supavit, Gerberi Danielle J, Baddour Larry M
Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA.
Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA.
Antibiotics (Basel). 2022 Dec 11;11(12):1798. doi: 10.3390/antibiotics11121798.
Blood cultures have been the gold standard for identifying pathogens in infective endocarditis (IE). Blood culture-negative endocarditis (BCNE), however, occurs in 40% or more of IE cases with the bulk of them due to recent antibiotic exposure prior to obtaining blood cultures. Increasingly, molecular techniques are being used for pathogen identification in cases of BCNE and more recently has included metagenomic next-generation sequencing (mNGS). We therefore performed a literature search on August 31, 2022, that assessed the mNGS in IE and 13 publications were identified and included in a systematic review. Eight (61.5%) of them focused only on IE with mNGS performed on cardiac valve tissue in four studies, plasma in three studies and cardiac implantable electronic devices (CIED) in one study. Gram-positive cocci, including Staphylococcus aureus (n = 31, 8.9%), coagulase-negative staphylococci (n = 61, 17.6%), streptococci (n = 130, 37.5%), and Enterococcus faecalis (n = 23, 6.6%) were the predominant organisms identified by mNGS. Subsequent investigations are needed to further define the utility of mNGS in BCNE and its impact on patient outcomes. Despite some pitfalls, mNGS seems to be of value in pathogen identification in IE cases, particularly in those with BCNE. This study was registered and on the Open Science Framework platform.
血培养一直是诊断感染性心内膜炎(IE)病原体的金标准。然而,血培养阴性的心内膜炎(BCNE)在40%或更多的IE病例中出现,其中大部分是由于在采集血培养之前近期使用了抗生素。越来越多的分子技术被用于BCNE病例的病原体鉴定,最近还包括宏基因组下一代测序(mNGS)。因此,我们于2022年8月31日进行了一项文献检索,评估了mNGS在IE中的应用,共识别出13篇出版物并纳入系统评价。其中8篇(61.5%)仅关注IE,4项研究对心脏瓣膜组织进行了mNGS检测,3项研究对血浆进行了检测,1项研究对心脏植入式电子设备(CIED)进行了检测。mNGS鉴定出的主要病原体为革兰氏阳性球菌,包括金黄色葡萄球菌(n = 31,8.9%)、凝固酶阴性葡萄球菌(n = 61,17.6%)、链球菌(n = 130,37.5%)和粪肠球菌(n = 23,6.6%)。需要进一步的研究来进一步明确mNGS在BCNE中的效用及其对患者预后的影响。尽管存在一些缺陷,但mNGS在IE病例的病原体鉴定中似乎具有价值,尤其是在BCNE病例中。本研究已在开放科学框架平台上注册。