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Abstract：
Background: Infectious endocarditis (IE) remains a critical condition despite all the medical advances in recent decades. Reliable pathogen identification is indispensable for precise therapy. The aim of this study was to evaluate the diagnostic and therapeutic benefit of additional polymerase chain reaction (PCR) in comparison with microbiological culture alone based on intraoperative tissue sampling for patients operated on due to IE. Methods: A total of 224 patients diagnosed with acute or subacute IE were analyzed. Intraoperatively resected infectious tissue was analyzed using both PCR and microbiological culture. Subsequently, the results of the detection of bacteria obtained based on intraoperative measurements from tissue via culture and PCR were compared with preoperative blood culture results. Furthermore, we evaluated the therapeutic impact of the culture and/or PCR results obtained from cardiac tissue. Results: The 224 patients were 63 ± 17 years old, and 64 (29%) were female. In total, 149 (67%) suffered from aortic valve endocarditis, 45 (45%) had mitral valve endocarditis, and 39 (18%) were afflicted with double-valve endocarditis. Prosthetic valve endocarditis was present in 70 (31%) patients. Pathogens were detected in 70% of the cases analyzed via PCR using cardiac valve tissue and in 25% of those analyzed via a culture of cardiac valve tissue; this figure was only 64% for preoperative blood culture. Overall, a pathogen was identified in 197 patients (88%), leading to antibiotic therapy. Targeted antibiotic therapy, based on the PCR results, was carried out in 37 cases and was conducted based on a culture from cardiac valve tissue in three cases. Finally, in 12% of patients, the causative pathogen remained unclear. Conclusions: For patients suffering endocarditis, PCR analysis is indispensable and superior to preoperative blood culture and intraoperative culture in detecting bacteria. Based on PCR testing, antibiotic therapy can be individually adjusted. The high precision of pathogen identification may lead to a significant reduction in IE-associated morbidity and mortality.
摘要：
背景：尽管近几十年来医学上取得了所有进展，但感染性心内膜炎（IE）仍然是一种危重症。可靠的病原体鉴定对于精确治疗是必不可少的。这项研究的目的是评估额外的聚合酶链反应（PCR）与单独的微生物培养相比，基于术中组织采样对IE手术患者的诊断和治疗益处。方法:对224例确诊为急性或亚急性IE患者进行分析。使用PCR和微生物培养分析术中切除的感染组织。随后，将术中通过培养和PCR从组织中获得的细菌检测结果与术前血培养结果进行比较.此外，我们评估了从心脏组织获得的培养物和/或PCR结果的治疗效果.结果:224例患者63±17岁,64（29％）为女性。总的来说,149（67%）主动脉瓣心内膜炎，45（45%）有二尖瓣心内膜炎，39例(18%)患有双瓣心内膜炎。70例（31％）患者存在人工瓣膜心内膜炎。在使用心脏瓣膜组织通过PCR分析的病例中，有70％检测到病原体，在通过心脏瓣膜组织培养物分析的病例中，有25％检测到病原体；对于术前血液培养，这一数字仅为64％。总的来说,在197名患者(88%)中发现了一种病原体，导致抗生素治疗。靶向抗生素治疗,根据PCR结果，在37例中进行，并在3例中基于心脏瓣膜组织的培养物进行。最后,在12%的患者中，致病病原体仍不清楚。结论：对于患有心内膜炎的患者，在细菌检测方面，PCR分析是必不可少的，并且优于术前血培养和术中培养。基于PCR检测,抗生素治疗可以单独调整。病原体鉴定的高精度可导致IE相关发病率和死亡率的显著降低。
