Molecular Approach to Diagnosis of Cardiovascular Implantable Electronic Device Infection

Area of Science:

• Cardiovascular medicine
• Infectious disease diagnostics
• Molecular microbiology

Background:

• Cardiovascular implantable electronic device (CIED) infections pose significant clinical challenges.
• Sonicate fluid (SF) is a promising specimen for diagnosing CIED infections, but culture methods often fail to detect causative organisms.
• A substantial proportion of CIED infections remain culture-negative, necessitating improved diagnostic approaches.

Purpose of the Study:

• To evaluate the diagnostic performance of 16S ribosomal RNA gene (rRNA) polymerase chain reaction (PCR)/sequencing for detecting microorganisms in SF.
• To compare the sensitivity of 16S rRNA PCR/sequencing with conventional SF culture for CIED infection diagnosis.

Main Methods:

• Analysis of 322 SF specimens from explanted CIEDs.
• Classification of cases into infected and non-infected groups based on clinical data.
• Comparison of results from 16S rRNA PCR/sequencing with SF culture findings.

Main Results:

• 16S rRNA PCR/sequencing demonstrated higher sensitivity (64%) compared to SF culture (57.5%) in detecting bacteria (P = .003).
• The molecular method identified pathogens in 28 of 118 culture-negative cases, predominantly staphylococci.
• A total of 278 SF samples were from infected cases, with 160 culture-positive and 118 culture-negative.

Conclusions:

• 16S rRNA PCR/sequencing is a more sensitive method for detecting bacteria in SF from explanted CIEDs than SF culture.
• This molecular technique improves the diagnosis of CIED infections, particularly in culture-negative scenarios.
• Enhanced pathogen identification via 16S rRNA PCR/sequencing can guide more effective treatment strategies for CIED infections.