血培养阴性感染性心内膜炎的手术治疗：结果及分子生物学成像作为诊断方法的作用†

Surgery for blood culture-negative infective endocarditis: outcomes and the role of molecular biological imaging as diagnostic approach†.

作者信息

Grubitzsch Herko, Puritz Johannes Erik, Greve Dustin, Biefer Hector Rodriguez Cetina, von Schöning Dinah, Kikhney Judith, Moter Annette, Sima Stefanie-Teodora, Schneider-Reigbert Matthias, Stegemann Miriam Songa, Pfäfflin Frieder, Falk Volkmar

机构信息

Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany.

Charité-Universitätsmedizin Berlin, Berlin, Germany.

出版信息

Eur J Cardiothorac Surg. 2024 Dec 26;67(1). doi: 10.1093/ejcts/ezae453.

DOI:10.1093/ejcts/ezae453

PMID:39680878

Abstract

OBJECTIVES

The study aimed to analyse outcomes of surgery for blood culture-negative infective endocarditis (BCNIE) and to evaluate the role of molecular biological imaging.

METHODS

Patients undergoing surgery for native or prosthetic valve endocarditis from 2013 to 2022 were analysed regarding blood culture-positive infective endocarditis (BCPIE) and BCNIE. For laboratory diagnostics in BCNIE, excised valves or prostheses underwent conventional microbiological culture and fluorescence in situ hybridization combined with 16S rRNA-gene polymerase chain reaction and sequencing (FISHseq).

RESULTS

Of 521 patients overall, we identified 473 patients (342 males, mean age 63 ± 14.4 years) with preoperative blood cultures: 396 with BCPIE (83.7%) and 77 with BCNIE (16.3%). Preoperative characteristics and operative procedures were comparable between groups and the calculated perioperative risk (EuroSCORE II) was identical (BCNIE: 12.2 ± 8.8%, BCPIE: 12.9 ± 11.9%, P = 0.788). At surgery, signs of infective endocarditis were present in 71%, missing in 18% and inconclusive in 10% of patients with BCNIE. While valve cultures alone identified pathogens in 32% of BCNIE patients, the combination with FISHseq confirmed the infective aetiology in 98% and identified causative pathogens in 52%. Overall, early mortality was similar in BCNIE (16.9%) and BCPIE (18.2%, P = 0.620), but increased in 37 BCNIE patients without pathogen identification compared to 40 patients with pathogen identification (27.0% vs 7.5%, P = 0.032).

CONCLUSIONS

Integrating FISHseq as molecular biological imaging technique into valve analysis algorithms in patients undergoing surgery for BCNIE increases diagnostic gain and potentially improves outcome.

摘要

目的

本研究旨在分析血培养阴性感染性心内膜炎（BCNIE）的手术结果，并评估分子生物学成像的作用。

方法

对2013年至2022年接受天然瓣膜或人工瓣膜心内膜炎手术的患者进行血培养阳性感染性心内膜炎（BCPIE）和BCNIE分析。对于BCNIE的实验室诊断，切除的瓣膜或假体进行常规微生物培养以及荧光原位杂交联合16S rRNA基因聚合酶链反应和测序（FISHseq）。

结果

在总共521例患者中，我们确定了473例术前进行血培养的患者（342例男性，平均年龄63±14.4岁）：396例为BCPIE（83.7%），77例为BCNIE（16.3%）。两组之间的术前特征和手术操作具有可比性，计算得出的围手术期风险（欧洲心脏手术风险评估系统II）相同（BCNIE：12.2±8.8%，BCPIE：12.9±11.9%，P = 0.788）。在手术中，BCNIE患者中71%存在感染性心内膜炎体征，18%未发现，10%不确定。仅瓣膜培养在32%的BCNIE患者中鉴定出病原体，而与FISHseq联合使用则在98%的患者中证实了感染病因，并在52%的患者中鉴定出致病病原体。总体而言，BCNIE患者的早期死亡率（16.9%）与BCPIE患者（18.2%，P = 0.620）相似，但与40例鉴定出病原体的患者相比，37例未鉴定出病原体的BCNIE患者的死亡率有所增加（27.0%对7.5%，P = 0.032）。