Etiologic Diagnosis of Infective Endocarditis by Broad-Range Polymerase Chain Reaction: A 3-Year Experience
We analyzed surgically resected endocardial specimens from 49 patients by broad-range PCR. PCR results were compared with (1) results of previous blood cultures, (2) results of culture and Gram staining of resected specimens, and (3) clinical data (Duke criteria). Molecular analyses of resected spec...
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| Veröffentlicht in: | Clinical infectious diseases 2003-07, Vol.37 (2), p.167-172 |
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| creator | Bosshard, Philipp Peter Kronenberg, Andreas Zbinden, Reinhard Ruef, Christian Böttger, Erik Christian Altwegg, Martin |
| description | We analyzed surgically resected endocardial specimens from 49 patients by broad-range PCR. PCR results were compared with (1) results of previous blood cultures, (2) results of culture and Gram staining of resected specimens, and (3) clinical data (Duke criteria). Molecular analyses of resected specimens and previous blood cultures showed good overall agreement. However, in 18% of patients with sterile blood cultures, bacterial DNA was found in the resected materials. When data from patients with definite or rejected cases of infective endocarditis (IE) were included, the sensitivity, specificity, and positive and negative predictive values of broad-range PCR were 82.6%, 100%, 100%, and 76.5%, respectively, overall, and 94.1%, 100%, 100%, and 90%, for cases of native valve endocarditis. The sensitivity, specificity, and positive and negative predictive values of culture of resected specimens from patients with native valve endocarditis were 17.6%, 88.9%, 75%, and 36.4%. We recommend broad-range PCR of surgically resected endocardial material in cases of possible IE, in cases of suspected IE in which blood cultures are sterile, and in cases in which organisms grow in blood cultures but only Duke minor criteria are met. We propose to add molecular techniques to the pathologic criteria of the Duke classification scheme. |
| doi_str_mv | 10.1086/375592 |
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PCR results were compared with (1) results of previous blood cultures, (2) results of culture and Gram staining of resected specimens, and (3) clinical data (Duke criteria). Molecular analyses of resected specimens and previous blood cultures showed good overall agreement. However, in 18% of patients with sterile blood cultures, bacterial DNA was found in the resected materials. When data from patients with definite or rejected cases of infective endocarditis (IE) were included, the sensitivity, specificity, and positive and negative predictive values of broad-range PCR were 82.6%, 100%, 100%, and 76.5%, respectively, overall, and 94.1%, 100%, 100%, and 90%, for cases of native valve endocarditis. The sensitivity, specificity, and positive and negative predictive values of culture of resected specimens from patients with native valve endocarditis were 17.6%, 88.9%, 75%, and 36.4%. We recommend broad-range PCR of surgically resected endocardial material in cases of possible IE, in cases of suspected IE in which blood cultures are sterile, and in cases in which organisms grow in blood cultures but only Duke minor criteria are met. We propose to add molecular techniques to the pathologic criteria of the Duke classification scheme.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/375592</identifier><identifier>PMID: 12856207</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Chicago, IL: The University of Chicago Press</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacterial diseases ; Bacterial endocarditis, myocarditis and pericarditis. Bacterial diseases of the aorta, limb vessels and lymphatic vessels ; Bacteriological Techniques - methods ; Biological and medical sciences ; Blood ; Cardiology. Vascular system ; Child ; DNA ; DNA, Bacterial - analysis ; Endocardial and cardiac valvular diseases ; Endocarditis ; Endocarditis, Bacterial - diagnosis ; Endocarditis, Bacterial - microbiology ; Endocarditis, Bacterial - pathology ; Female ; Heart ; Heart valves ; Human bacterial diseases ; Humans ; Infectious diseases ; Major Articles ; Male ; Medical sciences ; Microorganisms ; Microscopy ; Middle Aged ; Pathology ; Polymerase chain reaction ; Polymerase Chain Reaction - methods ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Sequence Analysis, DNA ; Sequencing ; Specimens ; Streptococcus</subject><ispartof>Clinical infectious diseases, 2003-07, Vol.37 (2), p.167-172</ispartof><rights>Copyright 2003 The Infectious Diseases Society of America</rights><rights>2003 by the Infectious Diseases Society of America 2003</rights><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c519t-6f43ff7df9e606ebd3e78a402702ce5f7a1de8fec67f6b3f594a2cc9f15d8cf13</citedby><cites>FETCH-LOGICAL-c519t-6f43ff7df9e606ebd3e78a402702ce5f7a1de8fec67f6b3f594a2cc9f15d8cf13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/4462418$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/4462418$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15034953$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12856207$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bosshard, Philipp Peter</creatorcontrib><creatorcontrib>Kronenberg, Andreas</creatorcontrib><creatorcontrib>Zbinden, Reinhard</creatorcontrib><creatorcontrib>Ruef, Christian</creatorcontrib><creatorcontrib>Böttger, Erik Christian</creatorcontrib><creatorcontrib>Altwegg, Martin</creatorcontrib><title>Etiologic Diagnosis of Infective Endocarditis by Broad-Range Polymerase Chain Reaction: A 3-Year Experience</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>We analyzed surgically resected endocardial specimens from 49 patients by broad-range PCR. PCR results were compared with (1) results of previous blood cultures, (2) results of culture and Gram staining of resected specimens, and (3) clinical data (Duke criteria). Molecular analyses of resected specimens and previous blood cultures showed good overall agreement. However, in 18% of patients with sterile blood cultures, bacterial DNA was found in the resected materials. When data from patients with definite or rejected cases of infective endocarditis (IE) were included, the sensitivity, specificity, and positive and negative predictive values of broad-range PCR were 82.6%, 100%, 100%, and 76.5%, respectively, overall, and 94.1%, 100%, 100%, and 90%, for cases of native valve endocarditis. The sensitivity, specificity, and positive and negative predictive values of culture of resected specimens from patients with native valve endocarditis were 17.6%, 88.9%, 75%, and 36.4%. We recommend broad-range PCR of surgically resected endocardial material in cases of possible IE, in cases of suspected IE in which blood cultures are sterile, and in cases in which organisms grow in blood cultures but only Duke minor criteria are met. We propose to add molecular techniques to the pathologic criteria of the Duke classification scheme.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bacterial diseases</subject><subject>Bacterial endocarditis, myocarditis and pericarditis. Bacterial diseases of the aorta, limb vessels and lymphatic vessels</subject><subject>Bacteriological Techniques - methods</subject><subject>Biological and medical sciences</subject><subject>Blood</subject><subject>Cardiology. Vascular system</subject><subject>Child</subject><subject>DNA</subject><subject>DNA, Bacterial - analysis</subject><subject>Endocardial and cardiac valvular diseases</subject><subject>Endocarditis</subject><subject>Endocarditis, Bacterial - diagnosis</subject><subject>Endocarditis, Bacterial - microbiology</subject><subject>Endocarditis, Bacterial - pathology</subject><subject>Female</subject><subject>Heart</subject><subject>Heart valves</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Major Articles</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microorganisms</subject><subject>Microscopy</subject><subject>Middle Aged</subject><subject>Pathology</subject><subject>Polymerase chain reaction</subject><subject>Polymerase Chain Reaction - methods</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Sequence Analysis, DNA</subject><subject>Sequencing</subject><subject>Specimens</subject><subject>Streptococcus</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0MtuEzEUBmALgegFeAKEzAJ2A_b4OuzaNKWVKoECSMDGcjzHwe3EDvYENW-P0UQtG8TKlv7Px0c_Qs8oeUOJlm-ZEqJrH6BDKphqpOjow3onQjdcM32Ajkq5JoRSTcRjdEBbLWRL1CG6mY8hDWkVHD4LdhVTCQUnjy-jBzeGX4DnsU_O5j6MNVnu8GlOtm8WNq4Af0zDbg3ZFsCzHzZEvABbX6X4Dp9g1nwDm_H8dgM5QHTwBD3ydijwdH8eoy_n88-zi-bqw_vL2clV4wTtxkZ6zrxXve9AEgnLnoHSlpNWkdaB8MrSHnRdTyovl8yLjtvWuc5T0WvnKTtGr6e5m5x-bqGMZh2Kg2GwEdK2GMW4pLyV_4VU61or_wu6nErJ4M0mh7XNO0OJ-dO_mfqv8MV-4na5hv6e7Quv4NUe2OLs4LONLpR7JwjjnWDVvZxc2m7-_dnzyVyXMeU7xblsOdU1bqY4lBFu72Kbb4xUdYS5-PrdnMuOLD6JUyPZb9PervQ</recordid><startdate>20030715</startdate><enddate>20030715</enddate><creator>Bosshard, Philipp Peter</creator><creator>Kronenberg, Andreas</creator><creator>Zbinden, Reinhard</creator><creator>Ruef, Christian</creator><creator>Böttger, Erik Christian</creator><creator>Altwegg, Martin</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>20030715</creationdate><title>Etiologic Diagnosis of Infective Endocarditis by Broad-Range Polymerase Chain Reaction: A 3-Year Experience</title><author>Bosshard, Philipp Peter ; Kronenberg, Andreas ; Zbinden, Reinhard ; Ruef, Christian ; Böttger, Erik Christian ; Altwegg, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c519t-6f43ff7df9e606ebd3e78a402702ce5f7a1de8fec67f6b3f594a2cc9f15d8cf13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bacterial diseases</topic><topic>Bacterial endocarditis, myocarditis and pericarditis. Bacterial diseases of the aorta, limb vessels and lymphatic vessels</topic><topic>Bacteriological Techniques - methods</topic><topic>Biological and medical sciences</topic><topic>Blood</topic><topic>Cardiology. Vascular system</topic><topic>Child</topic><topic>DNA</topic><topic>DNA, Bacterial - analysis</topic><topic>Endocardial and cardiac valvular diseases</topic><topic>Endocarditis</topic><topic>Endocarditis, Bacterial - diagnosis</topic><topic>Endocarditis, Bacterial - microbiology</topic><topic>Endocarditis, Bacterial - pathology</topic><topic>Female</topic><topic>Heart</topic><topic>Heart valves</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Major Articles</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microorganisms</topic><topic>Microscopy</topic><topic>Middle Aged</topic><topic>Pathology</topic><topic>Polymerase chain reaction</topic><topic>Polymerase Chain Reaction - methods</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Sequence Analysis, DNA</topic><topic>Sequencing</topic><topic>Specimens</topic><topic>Streptococcus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bosshard, Philipp Peter</creatorcontrib><creatorcontrib>Kronenberg, Andreas</creatorcontrib><creatorcontrib>Zbinden, Reinhard</creatorcontrib><creatorcontrib>Ruef, Christian</creatorcontrib><creatorcontrib>Böttger, Erik Christian</creatorcontrib><creatorcontrib>Altwegg, Martin</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bosshard, Philipp Peter</au><au>Kronenberg, Andreas</au><au>Zbinden, Reinhard</au><au>Ruef, Christian</au><au>Böttger, Erik Christian</au><au>Altwegg, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Etiologic Diagnosis of Infective Endocarditis by Broad-Range Polymerase Chain Reaction: A 3-Year Experience</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2003-07-15</date><risdate>2003</risdate><volume>37</volume><issue>2</issue><spage>167</spage><epage>172</epage><pages>167-172</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>We analyzed surgically resected endocardial specimens from 49 patients by broad-range PCR. PCR results were compared with (1) results of previous blood cultures, (2) results of culture and Gram staining of resected specimens, and (3) clinical data (Duke criteria). Molecular analyses of resected specimens and previous blood cultures showed good overall agreement. However, in 18% of patients with sterile blood cultures, bacterial DNA was found in the resected materials. When data from patients with definite or rejected cases of infective endocarditis (IE) were included, the sensitivity, specificity, and positive and negative predictive values of broad-range PCR were 82.6%, 100%, 100%, and 76.5%, respectively, overall, and 94.1%, 100%, 100%, and 90%, for cases of native valve endocarditis. The sensitivity, specificity, and positive and negative predictive values of culture of resected specimens from patients with native valve endocarditis were 17.6%, 88.9%, 75%, and 36.4%. We recommend broad-range PCR of surgically resected endocardial material in cases of possible IE, in cases of suspected IE in which blood cultures are sterile, and in cases in which organisms grow in blood cultures but only Duke minor criteria are met. We propose to add molecular techniques to the pathologic criteria of the Duke classification scheme.</abstract><cop>Chicago, IL</cop><pub>The University of Chicago Press</pub><pmid>12856207</pmid><doi>10.1086/375592</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Bacterial diseases Bacterial endocarditis, myocarditis and pericarditis. Bacterial diseases of the aorta, limb vessels and lymphatic vessels Bacteriological Techniques - methods Biological and medical sciences Blood Cardiology. Vascular system Child DNA DNA, Bacterial - analysis Endocardial and cardiac valvular diseases Endocarditis Endocarditis, Bacterial - diagnosis Endocarditis, Bacterial - microbiology Endocarditis, Bacterial - pathology Female Heart Heart valves Human bacterial diseases Humans Infectious diseases Major Articles Male Medical sciences Microorganisms Microscopy Middle Aged Pathology Polymerase chain reaction Polymerase Chain Reaction - methods Predictive Value of Tests Retrospective Studies Sensitivity and Specificity Sequence Analysis, DNA Sequencing Specimens Streptococcus |
| title | Etiologic Diagnosis of Infective Endocarditis by Broad-Range Polymerase Chain Reaction: A 3-Year Experience |
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