title: Metagenomic analysis for detecting pathogens in culture-negative infective endocarditis.
abstract: Pathogen identification is important for proper diagnosis and optimal treatment of infective endocarditis (IE). Blood and valve cultures are the gold standard for detecting pathogens responsible for IE. However, these tests only detect culturable pathogens, and have low sensitivity, especially in patients previously treated with antibiotics. Culture-negative IE is still a major clinical problem and a diagnostic challenge. Recently, metagenomic analysis using next generation sequencing has been used to detect pathogens directly from clinical samples. However, there are very few reports of the use of metagenomic analysis for pathogen identification in culture-negative IE cases and the usefulness of this new method is unknown. Here, we report a case of successful pathogen detection with metagenomic analysis in a patient of culture-negative IE. The patient underwent valve replacement surgery and received antibiotics for 5 weeks and survived. Using metagenomic analysis of resected vegetation, we detected Abiotrophia defectiva, which is often associated with culture-negative IE due to its fastidious growth. This method may be useful for pathogen identification in future cases of culture-negative IE.
authors.affiliation: Department of Infectious Diseases, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan. Electronic address: yuuto.fukui@med.toho-u.ac.jp.
authors.forename: Yuto
authors.initials: Y
authors.lastname: Fukui
authors.affiliation: Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University School of Medicine, 5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Aoki
authors.affiliation: Department of Cardiovascular Surgery, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Shinnosuke
authors.initials: S
authors.lastname: Okuma
authors.affiliation: Department of Infectious Diseases, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University School of Medicine, 5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ishii
authors.affiliation: Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University School of Medicine, 5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tateda
mesh_terms: D058835:Abiotrophia / Q000235:genetics; D000328:Adult; D004696:Endocarditis / Q000175:diagnosis* / Q000382:microbiology*; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology*; D006801:Humans; D008297:Male; D056186:Metagenomics / Q000379:methods
keywords: Abiotrophia defectiva; Culture-negative infective endocarditis; Metagenomic analysis; Next generation sequencing