title: A commercially available multiplex real-time PCR for detection of pathogens in cardiac valves from patients with infective endocarditis.
abstract: Infective endocarditis (IE) is a life-threatening condition, burdened by high mortality. Current guidelines recommend that, in case of negative culture result, tissues from excised heart valves or vegetations from patients with suspected IE should be referred for broad-range bacterial PCR and sequencing. In this proof-of-concept study, the diagnostic utility of the commercially available multiplex real-time PCR system SeptiFast (SF), performed on cardiac valves, was evaluated in a selected population of 20 patients with definite IE of known origin, in comparison with culture. A significant difference was found between SF and culture in the rate of pathogen detection (19 versus 3 respectively; chi-square 14.06; P=0.0002). SF sensitivity was 95%; specificity, 100%; positive predictive value (PPV), 100%; and negative predictive value (NPV), 83.3%. Culture sensitivity was 15%; specificity, 100%; PPV, 100%; and NPV, 22.7%. SF assay, performed on culture-negative excised heart valves, can be useful for the etiological diagnosis of IE.
authors.affiliation: Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Leli
authors.affiliation: Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Italy.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Moretti
authors.affiliation: Department of Experimental Medicine and Biochemical Sciences, Infectious Disease Section, University of Perugia, Perugia, Italy.
authors.forename: Maria Bruna
authors.initials: MB
authors.lastname: Pasticci
authors.affiliation: Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Cenci
authors.affiliation: Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bistoni
authors.affiliation: Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Italy. Electronic address: antonella.mencacci@unipg.it.
authors.forename: Antonella
authors.initials: A
authors.lastname: Mencacci
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000382:microbiology*; D006351:Heart Valves / Q000382:microbiology*; D006801:Humans; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity
keywords: Heart valve; Infective endocarditis; Real-time PCR; SeptiFast