Intraoperative Polymerase Chain Reaction from Cardiac Valve Tissue Is Beneficial for Guiding Further Therapy in...

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• Infectious endocarditis (IE) remains a significant clinical challenge despite medical advancements.
• Accurate pathogen identification is crucial for effective IE treatment.
• Intraoperative tissue sampling offers a direct source for microbial analysis.

Purpose of the Study:

• To compare the diagnostic utility of polymerase chain reaction (PCR) with microbiological culture for pathogen detection in IE.
• To evaluate the therapeutic benefits of PCR-based pathogen identification in patients undergoing surgery for IE.
• To assess the impact of intraoperative tissue analysis versus preoperative blood cultures.

Main Methods:

• A cohort of 224 patients with acute or subacute IE undergoing surgery was analyzed.
• Intraoperatively resected cardiac tissue was subjected to both PCR and microbiological culture.
• Results were compared with preoperative blood culture findings and subsequent therapeutic decisions.

Main Results:

• PCR detected pathogens in 70% of tissue samples, significantly higher than culture (25%) and blood culture (64%).
• Overall pathogen identification was achieved in 88% of patients, guiding antibiotic therapy.
• Targeted antibiotic therapy based on PCR results was administered in 37 cases.

Conclusions:

• PCR analysis of cardiac tissue is indispensable and superior to blood cultures and intraoperative cultures for bacterial detection in IE.
• PCR enables precise, individualized antibiotic therapy, potentially lowering IE-associated morbidity and mortality.
• This diagnostic method enhances pathogen identification accuracy in complex IE cases.