This Article Full Text Full Text (PDF) All Versions of this Article: 111/11/1415    most recent 01.CIR.0000158481.07569.8Dv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Breitkopf, C. Articles by Becker, K. Search for Related Content PubMed PubMed Citation Articles by Breitkopf, C. Articles by Becker, K. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB HEXAMETHYL-P-ROSANILINE CHLORIDE Related Collections Other diagnostic testing Related Article

(Circulation. 2005;111:1415-1421.)
© 2005 American Heart Association, Inc.

Valvular Heart Disease

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

Claudia Breitkopf, MD; Dieter Hammel, MD; Hans H. Scheld, MD; Georg Peters, MD; Karsten Becker, MD

From the Institute of Medical Microbiology (C.B., G.P., K.B.) and Department of Thoracic and Cardiovascular Surgery (D.H., H.H.S.), University of Münster Hospital, Münster, Germany.

Correspondence to Karsten Becker, MD, Institute of Medical Microbiology, University of Münster Hospital, D-48149 Münster, Germany. E-mail kbecker{at}uni-muenster.de

Received May 8, 2004; revision received October 22, 2004; accepted December 17, 2004.

Background— Even today, infective endocarditis (IE) remains a severe and potentially fatal disease demanding sophisticated diagnostic strategies for detection of the causative microorganisms. Despite the use of appropriate laboratory techniques, classic microbiological diagnostics are characterized by a high rate of negative results.

Methods and Results— Broad-range polymerase chain reaction (PCR) targeting bacterial and fungal rDNA followed by direct sequencing was applied to excised heart valves (n=52) collected from 51 patients with suspected infectious endocarditis and from 16 patients without any signs of IE during an 18-month period. The sensitivity, specificity, and the positive and negative predictive values for the bacterial broad-range PCR were 41.2%, 100.0%, 100.0%, and 34.8%, respectively, compared with 7.8%, 93.7%, 80.0%, and 24.2% for culture and 11.8%, 100.0%, 100.0%, and 26.2% for Gram staining. Without exception, database analyses allowed identification up to the (sub)species level comprising streptococcal (n=13), staphylococcal (n=4), enterococcal (n=2), and other signature sequences such as Bartonella quintana and Nocardia paucivorans. Fungal ribosomal sequences were not amplified. All valve tissues of the reference group were negative for both PCR and conventional methods, except one sample that was contaminated by molds.

Conclusions— Culture-independent molecular methods substantially improve the diagnostic outcome of microbiological examination of excised heart valves. Importantly, this was true not only for fastidious, slow-growing, and/or nonculturable microorganisms but also for easy-to-culture pathogens such as streptococci and staphylococci. Both patient management and empiric antibiotic therapy of IE are likely to benefit from improved knowledge of the spectrum of pathogens now causing IE.

Key Words: diagnosis • infection • polymerase chain reaction • surgery • valves

Related Article:

Polymerase Chain Reaction to Diagnose Infective Endocarditis: Will It Replace Blood Cultures?

Peter A. Rice and Guillermo E. Madico
Circulation 2005 111: 1352-1354. [Extract] [Full Text]

This article has been cited by other articles:

				M. Hussain, C. von Eiff, B. Sinha, I. Joost, M. Herrmann, G. Peters, and K. Becker eap Gene as Novel Target for Specific Identification of Staphylococcus aureus J. Clin. Microbiol., February 1, 2008; 46(2): 470 - 476. [Abstract] [Full Text] [PDF]

				I. T. Carmona, P. Diz Dios, and C. Scully Efficacy of Antibiotic Prophylactic Regimens for the Prevention of Bacterial Endocarditis of Oral Origin J. Dent. Res., December 1, 2007; 86(12): 1142 - 1159. [Abstract] [Full Text] [PDF]

				J.-H. Mikesch, A. Rudat, M. Zuhlsdorf, W. E. Berdel, R. Mesters, B. Conrad, K. Becker, W. Fegeler, and C. Anthoni Subcutaneous Zygomycosis in Neutropenia J. Clin. Oncol., October 20, 2007; 25(30): 4844 - 4845. [Full Text] [PDF]

				K. Trulzsch, B. Grabein, P. Schumann, A. Mellmann, U. Antonenka, J. Heesemann, and K. Becker Staphylococcus pettenkoferi sp. nov., a novel coagulase-negative staphylococcal species isolated from human clinical specimens Int J Syst Evol Microbiol, July 1, 2007; 57(7): 1543 - 1548. [Abstract] [Full Text] [PDF]

				B D Prendergast The changing face of infective endocarditis Heart, July 1, 2006; 92(7): 879 - 885. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola The Year in Valvular Heart Disease J. Am. Coll. Cardiol., January 17, 2006; 47(2): 427 - 439. [Full Text] [PDF]

				P. A. Rice and G. E. Madico Polymerase Chain Reaction to Diagnose Infective Endocarditis: Will It Replace Blood Cultures? Circulation, March 22, 2005; 111(11): 1352 - 1354. [Full Text] [PDF]