Kim Myeongji, Fida Madiha, Abu Saleh Omar M, Ranganath Nischal
Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Pathogens. 2025 May 23;14(6):518. doi: 10.3390/pathogens14060518.
Infective endocarditis (IE) remains a diagnostic challenge, particularly in cases where microbiological diagnosis is not established. Advances in molecular diagnostics have expanded the ability to identify causative pathogens beyond traditional culture-based methods. This review explores the role of molecular assays, including pathogen-specific PCR, multiplex PCR, broad-range PCR, and shotgun metagenomic sequencing, in diagnosing IE. These molecular techniques enhance pathogen detection, especially in patients with prior antibiotic exposure, and improve diagnostic accuracy in culture-negative IE. Broad-range PCR assays and metagenomic sequencing offer the untargeted detection of a wide spectrum of organisms. Despite their advantages, limitations such as availability, interpretation challenges, and a lack of antimicrobial susceptibility testing remain. A multimodal approach integrating molecular diagnostics with conventional methods is essential to optimize patient management. Further research is needed to refine diagnostic algorithms and improve cost-effectiveness in clinical practice.
感染性心内膜炎（IE）仍然是一个诊断难题，尤其是在微生物学诊断未确立的情况下。分子诊断技术的进步扩展了超越传统基于培养方法识别致病病原体的能力。本综述探讨了分子检测方法，包括病原体特异性PCR、多重PCR、广谱PCR和鸟枪法宏基因组测序，在IE诊断中的作用。这些分子技术增强了病原体检测能力，尤其是在先前使用过抗生素的患者中，并提高了血培养阴性IE的诊断准确性。广谱PCR检测和宏基因组测序提供了对广泛生物体的非靶向检测。尽管它们具有优势，但仍存在诸如可用性、解读挑战以及缺乏抗菌药物敏感性检测等局限性。将分子诊断与传统方法相结合的多模式方法对于优化患者管理至关重要。需要进一步研究以完善诊断算法并提高临床实践中的成本效益。
