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Table 4 Summary of heart valve 16S ribosomal PCR results from patients with definite IE according to Duke’s criteria: literature review

From: Development and evaluation of a novel fast broad-range 16S ribosomal DNA PCR and sequencing assay for diagnosis of bacterial infective endocarditis: multi-year experience in a large Canadian healthcare zone and a literature review

Study (Reference)

Location

Median duration of pre-operative antibiotic treatment (days)

Cases/Controlsa

Cases with positive pre-operative blood culture(s)

Nucleotide position of primers in E. coli 16S rRNA gene

Agreement of HV culture and 16s PCR

HV culture sensitivity/specificity

Sensitivity

Specificity

PPV

NPV

1 (Goldenberger, [8])

Switzerland

NR b

18

14/18 (77.8 %)

8-806

2/18 (11.1 %)

11.1/100 %

93.3 %

66.7 %

93.3 %

66.7 %

2 (Gauduchon, [13])

France

31.5 (range, 8 to 150)

29/23 c

21/29 (72.4 %)

911-930 and 1390-1371

27/29 (93.1 %) c

NR

ND

ND

ND

ND

3 (Lang, [19])

UK

NR d

28/61

20/28 (71.4 %)

1522-1540 and 1170-1189

14/20 (70 %)

NR

ND

ND

ND

ND

4 (Breitkopf, [23])

Germany

NR

51/16

7/21 (33.3 %)

8-27 and 907-926

None

7.8/93.7 %

41.2 %

100 %

100 %

34.8 %

5 (Greub, [15])

France

NR

127/118

57/127 (44.9 %)

536-1050

14/68 (20.6 %)

13/98 %

61 %

100 %

100 %

74 %%

6 (Rovery, [24])

France

19.5 (range, 1–150)

147

NR

536-1050

64/95 (67 %) e

NR

ND

ND

ND

ND

7 (Kotilainen, [18])

Finland

19.6 (range 1–58d)

28/18

20/28 (71.4 %)

1054-1077 and 1950-1926

18/25 (72 %)

13.1/100 %

43.1 %

100 %

100 %

58.1 %

8 (Marin, [9])

Spain

10 (range, 1–25)

35/120

31/35 (88.6 %)

783-806 and 1389-1370

16/35 (45.7 %)

24.3/56.4 %

96 %

95.3 %

98.4 %

88.5 %

9 (Volstedlund, [25])

Denmark

19.3 (range, 0–90)

57/10

50/57 (87.7 %)

341-534

19/57 (33.3 %)

26/62 %

72 %

100 %

100 %

62 %

10 (Fournier, [30]) g

France

NR

549/191/19

All patients had negative blood culture

Same as study (2) 536F and RP2

45.6 %

45.7 %/NR

69.2 %

ND

ND

ND

11 (Miyazato, 2011)

Japan

 

19

15/19 (79 %)

8UA and 1485B

None: 79 % had a positive Gram stain

None were positive

100 %

100 %

79 %

100 %

12 (Vondracek, [27])

Sweden

NR

57/61

48/57 (84 %)

334-939

20/57 (35.1 %)

23/87 %

77 %

100 %

100 %

87 %

13 (Boussier, [28]) f

France

NR

31

23/31 (74.2 %)

Same as (2) and 8-27 and 1510-1492

5/31 (16.1 %)

32.3/100 %

78 %

100 %

100 %

61.5 %

14 (Kemp, [17])

Denmark

NR

56/36

36/56 (64.3 %)

8-534

7/42 (16.7 %)

16.7/100 %

88 %

61.5 %

88 %

57.1 %

15 (Sadaka, [29]) g

Egypt

NR

19

All blood cultures were negative

1522-1540 and 1170-1189

5/6 (83.3 %)

62.5 %/NR

ND

ND

ND

ND

16 (Harris, [16])

Ireland, UK

NR

47

35/47 (74.5 %)

16S Fa, 16S Fb and 16SR (320 bp)

29/47 (61.7 %)

NR

67 %

91 %

96 %

46 %

17 (Leli, [31])h

Italy

NR

20

NR

Septifast (Roche)

3/19 (15.8 %)

15.8/100 %

95 %

100 %

100 %

83.3 %

18 (Marsch, [32]) i

Germany

NR

46

NR

UMD™, Molzym

27/46 (56.7 %)

32.1/100 %

61 %

ND

ND

ND

  1. aOnly data for definite IE cases is included. Some studies (3, 7, and 9) also enrolled a small number of cases with possible IE according to Duke’s criteria. Controls were patients undergoing cardiac surgery for non-infective reasons
  2. bNot reported (NR)
  3. cDefinite IE was diagnosed by histology in the 52 cases; 29 definite IE cases were included and 23 cases with no evidence of IE on histology of heart valve tissue. PCR results were compared to histology and not culture in this study
  4. dCases divided into an active group (n = 19) that was on antimicrobial therapy at the time of surgery, and the resolved group (N = 9) who had completed treatment (time period 3 months to 7 years after treatment at the time of cardiac surgery, and nine others with possible IE
  5. eBacterial DNA was amplified by PCR significantly more often (64/95, 67 %) in HV with histological evidence of IE than valves that had no histological evidence of IE (21/55, 38 %) (p = 0.001)
  6. fThis study used a two-step PCR procedure: first, a real-time method, then a conventional end-point PCR was applied to HV samples to improve the sensitivity of molecular detection from 38 to 58 %
  7. gBoth of these studies only enrolled patients with culture negative endocarditis (i.e., all patients had clinical evidence of IE but negative blood cultures)
  8. hPCR on heart valve tissue was performed using a commercial real-time PCR assay (SeptiFast, Roche Molecular Systems, Mannheim Germany)
  9. iPCR of heart valve tissue was performed using a commercial assay (UDM™, Molyzm, Bremen, Germany) that uses both 16S rRNA bacterial primers and 18S rRNA fungal primers
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BMC Infectious Diseases

ISSN: 1471-2334

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