title: Comparison of PCR-Electrospray Ionization Mass Spectrometry with 16S rRNA PCR and Amplicon Sequencing for Detection of Bacteria in Excised Heart Valves.
abstract: Identification of the causative pathogen of infective endocarditis (IE) is crucial for adequate management and therapy. A broad-range PCR-electrospray ionization mass spectrometry (PCR-ESI-MS) technique was compared with broad-spectrum 16S rRNA PCR and amplicon sequencing (16S rRNA PCR) for the detection of bacterial pathogens in 40 heart valves obtained from 34 definite infective endocarditis patients according to the modified Duke criteria and six nonendocarditis patients. Concordance between the two molecular techniques was 98% for being positive or negative, 97% for concordant identification up to the genus level, and 77% for concordant identification up to the species level. Sensitivity for detecting the causative pathogen (up to the genus level) in excised heart valves was 88% for 16S rRNA PCR and 85% for PCR-ESI-MS; the specificity was 83% for both methods. The two molecular techniques were significantly more sensitive than valve culture (18%) and accurately identified bacteria in excised heart valves. In eight patients with culture-negative IE, the following results were obtained: concordant detection of Coxiella burnetii (n = 2), Streptococcus gallolyticus (n = 1), Propionibacterium acnes (n = 1), and viridans group streptococci (n = 1) by both molecular tests, detection of P. acnes by PCR-ESI-MS whereas the 16S rRNA PCR was negative (n = 1), and a false-negative result by both molecular techniques (n = 2). In one case of IE caused by viridans streptococci, PCR-ESI-MS was positive for Enterococcus spp. The advantages of PCR-ESI-MS compared to 16S rRNA PCR are its automated workflow and shorter turnaround times.
authors.affiliation: University Hospitals of Leuven, Clinical Department of Laboratory Medicine, Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Peeters
authors.affiliation: University Hospitals of Leuven, Clinical Department of Cardiothoracic Surgery, Leuven, Belgium.|KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
authors.affiliation: University Hospitals of Leuven, Clinical Department of Laboratory Medicine, Leuven, Belgium.
authors.forename: Kurt
authors.initials: K
authors.lastname: Beuselinck
authors.affiliation: University Hospitals of Leuven, Clinical Department of Internal Medicine, Leuven, Belgium.|KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium.
authors.forename: Willy E
authors.initials: WE
authors.lastname: Peetermans
authors.affiliation: KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium.|University Hospitals of Leuven, Clinical Department of Cardiology, Leuven, Belgium.
authors.forename: Marie-Christin
authors.initials: MC
authors.lastname: Herregods
authors.affiliation: University Hospitals of Leuven, Clinical Department of Laboratory Medicine, Leuven, Belgium.
authors.forename: Stefanie
authors.identifier: 0000-0002-4338-1929
authors.initials: S
authors.lastname: Desmet
authors.affiliation: University Hospitals of Leuven, Clinical Department of Laboratory Medicine, Leuven, Belgium katrien.lagrou@uzleuven.be.|KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: Lagrou
mesh_terms: D001419:Bacteria / Q000737:chemistry / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004696:Endocarditis / Q000175:diagnosis*; D005188:False Negative Reactions; D006351:Heart Valves / Q000382:microbiology*; D006801:Humans; D016133:Polymerase Chain Reaction / Q000379:methods*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017422:Sequence Analysis, DNA / Q000379:methods*; D021241:Spectrometry, Mass, Electrospray Ionization / Q000379:methods*
chemical_list: D012336:RNA, Ribosomal, 16S