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. 2023 Feb 3:13:1107170.
doi: 10.3389/fcimb.2023.1107170. eCollection 2023.

Application of metagenomic next-generation sequencing in patients with infective endocarditis

Shao-Lin Li  1 , Xi Zhao  1 , Jun-Zhong Tao  1 , Zhen-Zhen Yue  1 , Xiao-Yan Zhao  1
Affiliations

Application of metagenomic next-generation sequencing in patients with infective endocarditis

Shao-Lin Li et al. Front Cell Infect Microbiol. .

Abstract

Objectives: Metagenomic next-generation sequencing (mNGS) technology is helpful for the early diagnosis of infective endocarditis, especially culture-negative infective endocarditis, which may guide clinical treatment. The purpose of this study was to compare the presence of culture-negative infective endocarditis pathogens versus culture-positive ones, and whether mNGS test results could influence treatment regimens for patients with routine culture-negative infective endocarditis.

Methods: The present study enrolled patients diagnosed with infective endocarditis and tested for mNGS in the First Affiliated Hospital of Zhengzhou University from February 2019 to February 2022 continuously. According to the culture results, patients were divided into culture-negative group (Group CN, n=18) and culture-positive group (Group CP, n=32). The baseline characteristics, clinical data, pathogens, 30 day mortality and treatment regimen of 50 patients with infective endocarditis were recorded and analyzed.

Results: Except for higher levels of PCT in the Group CN [0.33 (0.16-2.74) ng/ml vs. 0.23 (0.12-0.49) ng/ml, P=0.042], there were no significant differences in the basic clinical data and laboratory examinations between the two groups (all P>0.05). The aortic valve and mitral valve were the most involved valves in patients with infective endocarditis (aortic valve involved: Group CN 10, Group CP 16; mitral valve involved: Group CN 8, Group CP 21; P>0.05) while 9 patients had multiple valves involved (Group CN 2, Group CP 7; P>0.05). The detection rate of non-streptococci infections in the Group CN was significantly higher than that in the Group CP (9/18 vs. 3/32, P=0.004). There was no significant difference in patients with heart failure hospitalization and all-cause death at 30 days after discharge (3 in Group CN vs. 4 in Group CP, P>0.05). It is worth noting that 10 patients with culture-negative infective endocarditis had their antibiotic regimen optimized after the blood mNGS.

Conclusions: Culture-negative infective endocarditis should be tested for mNGS for early diagnosis and to guide clinical antibiotic regimen.

Keywords: antibiotic regimen; culture-negative; culture-positive; infective endocarditis; metagenomic next-generation sequencing.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow Chart.
Figure 2
Figure 2
Pathogens of IE detected by blood mNGS and number of cases. mNGS, metagenomic next-generation sequencing; IE, infective endocarditis.
Figure 3
Figure 3
The main types of microbes in culture-negative IE and culture-positive IE patients. IE, infective endocarditis.
See this image and copyright information in PMC

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