Molecular Biological Methods in The Etiological Diagnostics of Infective Endocarditis

Area of Science:

• Infectious Diseases
• Molecular Diagnostics
• Cardiology

Background:

• Infective endocarditis (IE) diagnosis relies heavily on microbiological and clinical criteria.
• Early and accurate etiological diagnosis is crucial for effective treatment and patient management.
• Standard microbiological blood cultures can have limitations in sensitivity and speed.

Purpose of the Study:

• To evaluate the role of early blood polymerase chain reaction (PCR) testing in diagnosing infective endocarditis (IE).
• To assess the improvement in etiological diagnosis algorithms using PCR alongside traditional methods.
• To determine the impact of early PCR testing on antibacterial therapy de-escalation.

Main Methods:

• Prospective study of 154 patients with confirmed IE (DUKE, 2015 criteria).
• Simultaneous microbiological (culture) and molecular biological (PCR/sequencing) blood tests performed at initial diagnosis.
• Comparison of results from both methods to assess diagnostic accuracy and concordance.

Main Results:

• PCR identified the causative agent in 21.4% of patients, including specific pathogens like Bartonella spp.
• Microbiological cultures identified the agent in 24.8% of patients.
• PCR increased diagnostic accuracy in one-third of patients, enabling reclassification of diagnoses and de-escalation of therapy in a third of cases.

Conclusions:

• Blood PCR is a highly informative method for etiological diagnosis of IE.
• Early PCR testing enhances pathogen identification accuracy, guiding effective antibacterial therapy.
• Integrating PCR into diagnostic algorithms improves IE management and treatment strategies.