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(Circulation. 2005;111:1352-1354.)
© 2005 American Heart Association, Inc.

Editorial

Polymerase Chain Reaction to Diagnose Infective Endocarditis

Will It Replace Blood Cultures?

Peter A. Rice, MD; Guillermo E. Madico, MD, PhD

From the Evans Biomedical Research Center, Boston University Medical Center, Boston, Mass.

Correspondence to Peter A. Rice, MD, Section of Infectious Diseases, Boston University Medical Center, 650 Albany St, Boston, MA 02118. E-mail parice@bu.edu

Key Words: Editorials • endocarditis • polymerase chain reaction • valves • blood-borne pathogens

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
In this issue of Circulation, Breitkopf and colleagues¹ report on a series of 52 excised heart valves on which they performed broad-range polymerase chain reaction (PCR) to identify microbes in valve tissues that were defined as having infective endocarditis (IE). Internal sequencing of amplicons, with specific "nested" primers to identify microbial subspecies, was performed after broad-range PCR. The authors report that on the basis of gross features and histopathology, 22 (42.3%) of the 52 valves, which otherwise had evidence of IE, also had microbial subspecies identified. Eight (44%) of 18 IE valves that were preceded by positive blood cultures, where blood culture data were available, were positive by broad-range PCR. von Reyn’s,² Duke,³ and modified Duke⁴ criteria use blood cultures as a major clinical criterion to predict IE and histopathologic evidence of IE on cardiac valves as "definite" evidence of IE. Arguably, these two criteria together represent the most definite evidence of disease. Therefore, it may seem enigmatic that between and among major criteria used for the diagnosis of IE, >50% of the valves in the Breitkopf et al series¹ did not yield a causative microorganism identified by broad-range PCR. At first glance, broad-range PCR may seem to be a highly sensitive method to detect the presence of microbes. Indeed, this method was 3-fold more sensitive than the Gram stains and cultures performed on these tissues combined.

See p 1415

	Drawbacks of PCR: Tradeoffs in Sensitivity and Specificity

 
Broad-range PCR is used to target commonly shared bacterial 16S rRNA genes (via pan-bacterial primers), and subsequently, direct sequencing . . . [Full Text of this Article]

Related Article:

Impact of a Molecular Approach to Improve the Microbiological Diagnosis of Infective Heart Valve Endocarditis

Claudia Breitkopf, Dieter Hammel, Hans H. Scheld, Georg Peters, and Karsten Becker
Circulation 2005 111: 1415-1421. [Abstract] [Full Text]

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