title: Antibiotic therapy following polymerase chain reaction diagnosis of infective endocarditis: a single centre experience.
abstract: OBJECTIVE
  Conventional culture methods often fail in the aetiological diagnosis of infective endocarditis (IE), complicating adequate IE treatment. Therefore, in addition to culture diagnostic methods, our clinical department uses a broad-range 16S and 18S rDNA polymerase chain reaction (PCR) and sequencing test to detect and identify IE agents.
  
  
  METHODS
  Between 2009 and 2013, we performed 246 valve replacements due to endocarditis. In 46 patients with culture-negative IE or incongruent preoperative microbiological diagnostics, heart valve (HV) samples were PCR-analysed and PCR products subsequently sequenced for phylogenetic analysis.
  
  
  RESULTS
  The molecular diagnosis led us to change the antibiotic regimen in 7 of 46 patients.
  
  
  CONCLUSIONS
  The PCR results demonstrate that the molecular test is a useful diagnostic tool for the rapid diagnosis of IE. Furthermore, the molecular diagnosis had a significant, direct impact on the therapy of IE. This suggests that using PCR can improve antibiotic treatment, particularly in cases of culture-negative IE. Consequently, molecular analysis of micro-organisms in HV samples should be performed routinely where preoperative diagnosis remains unclear.
authors: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Georg
authors: G
authors: Marsch
authors: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Peter
authors: P
authors: Orszag
authors: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Bakr
authors: B
authors: Mashaqi
authors: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany kuehn.christian@mh-hannover.de.
authors: Christian
authors: C
authors: Kuehn
authors: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Axel
authors: A
authors: Haverich
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000032:analysis*; D004275:DNA, Ribosomal / Q000032:analysis; D004696:Endocarditis / Q000382:microbiology / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal
keywords: Antibiotic therapy; Blood culture-negative endocarditis; Broad-range 16S and 18S rDNA polymerase chain reaction; Infective endocarditis