TY - JOUR
T1 - Microbiological diagnosis in cardiac implantable electronic device infections detected by sonication and next-generation sequencing
AU - Olsen, Thomas
AU - Justesen, Ulrik Stenz
AU - Nielsen, Jens Cosedis
AU - Jørgensen, Ole Dan
AU - Sandgaard, Niels Christian Foldager
AU - Ravn, Christen
AU - Gerdes, Christian
AU - Thøgersen, Anna Margrethe
AU - Gill, Sabine
AU - Fuursted, Kurt
AU - Johansen, Jens Brock
N1 - Funding Information:
Disclosures: Dr Nielsen received a grant from the Novo Nordisk Foundation ( NNF16OC0018658 ). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
Funding sources: This work was supported by the Danish Heart Association and the Region of Southern Denmark (15-R99-A5950-22895, 16/36792).
PY - 2022/6
Y1 - 2022/6
N2 - Background: Device-related infection (DRI) is a severe complication of treatment with cardiac implantable electronic devices. Identification of the causative pathogen is essential for optimal treatment, but conventional methods often are inadequate. Objective: The purpose of this study was to improve microbiological diagnosis in DRI using sonication and next-generation sequencing analysis. The primary objective was identification of causative pathogens. The secondary objective was estimation of the sensitivity of different microbiological methods in detecting the causative pathogen. Methods: Consecutive patients with clinical signs of DRI between October 2016 and January 2019 from 3 tertiary centers in Denmark were included in the study. Patients underwent a diagnostic approach, including blood cultures and perioperative collection of microbiological samples (pocket swab, pocket tissue biopsies, generator, and leads). Conventional culturing was performed, and device components were sonicated and examined with an amplicon-based metagenomic analysis using next-generation sequencing. The results were compared with a reference standard–identified causative pathogen. Results: In 110 patients with clinical signs of pocket (n = 50) or systemic DRI (n = 60), we collected 109 pocket swabs, 220 pocket tissue biopsies, 106 generators, 235 leads, and a minimum 1 set of blood cultures from 102 patients. Combining all findings, we identified the causative pathogen in 95% of cases, irrespective of DRI type. The usability of each microbiological method differed between DRI types. In pocket DRI, next-generation sequencing analysis of generators achieved sensitivity of 90%. For systemic DRI, blood cultures reached sensitivity of 93%. Conclusion: Using a strategy including sonication and next-generation sequencing, we identified the causative pathogen in 95% of DRI. Sensitivity of microbiological methods differed according to the type of DRI.
AB - Background: Device-related infection (DRI) is a severe complication of treatment with cardiac implantable electronic devices. Identification of the causative pathogen is essential for optimal treatment, but conventional methods often are inadequate. Objective: The purpose of this study was to improve microbiological diagnosis in DRI using sonication and next-generation sequencing analysis. The primary objective was identification of causative pathogens. The secondary objective was estimation of the sensitivity of different microbiological methods in detecting the causative pathogen. Methods: Consecutive patients with clinical signs of DRI between October 2016 and January 2019 from 3 tertiary centers in Denmark were included in the study. Patients underwent a diagnostic approach, including blood cultures and perioperative collection of microbiological samples (pocket swab, pocket tissue biopsies, generator, and leads). Conventional culturing was performed, and device components were sonicated and examined with an amplicon-based metagenomic analysis using next-generation sequencing. The results were compared with a reference standard–identified causative pathogen. Results: In 110 patients with clinical signs of pocket (n = 50) or systemic DRI (n = 60), we collected 109 pocket swabs, 220 pocket tissue biopsies, 106 generators, 235 leads, and a minimum 1 set of blood cultures from 102 patients. Combining all findings, we identified the causative pathogen in 95% of cases, irrespective of DRI type. The usability of each microbiological method differed between DRI types. In pocket DRI, next-generation sequencing analysis of generators achieved sensitivity of 90%. For systemic DRI, blood cultures reached sensitivity of 93%. Conclusion: Using a strategy including sonication and next-generation sequencing, we identified the causative pathogen in 95% of DRI. Sensitivity of microbiological methods differed according to the type of DRI.
KW - Cardiac implantable electronic device
KW - Cardiac implantable electronic device infection
KW - Device-related infection
KW - Infection
KW - Molecular microbiology
KW - Next-generation sequencing
KW - Sonication
U2 - 10.1016/j.hrthm.2022.01.039
DO - 10.1016/j.hrthm.2022.01.039
M3 - Journal article
C2 - 35124230
AN - SCOPUS:85125932103
SN - 1547-5271
VL - 19
SP - 901
EP - 908
JO - Heart Rhythm
JF - Heart Rhythm
IS - 6
ER -