Key result
FISHseq identified intraoperative pathogens in 53% of patients with CIED infections compared to 42% with standard cultivation, and detected pathogens in 62% vs 23% of preoperatively negative cases.
Why the study?
In patients with CIED infections, identifying causative pathogens is complicated by biofilm formation and previous antibiotic therapy.
Does FISHseq improve the detection of causative pathogens compared to standard microbiological cultivation in patients with CIED infections?
Observational (n=36)
Does FISHseq improve the detection of causative pathogens compared to standard microbiological cultivation in patients with CIED infections?
Absolute Event Rate: 53% vs 42%
FISHseq is a valuable adjunctive tool that improves the detection of causative microorganisms in CIED infections, particularly when preoperative cultures are negative.
May enhance pathogen detection in CIED infections; leaves open need for outcome trials before routine adoption.
AIMS: In patients with infections of cardiac implantable electronic devices (CIEDs), the identification of causative pathogens is complicated by biofilm formations and previous antibiotic therapy. In this work, the impact of an additional fluorescence in situ hybridization (FISH), in combination with polymerase chain reaction and sequencing (FISHseq) was investigated. METHODS AND RESULTS: In 36 patients with CIED infections, FISHseq of explanted devices was performed and compared with standard microbiological cultivation of preoperative and intraoperative samples. The mean age was 61.9 (±16.2) years; 25 (69.4%) were males. Most patients (62.9%) had heart failure with reduced ejection fraction. Infections occurred as endoplastits (n = 26), isolated local generator pocket infection (n = 8), or both (n = 2); CIED included cardiac resynchronization therapy defibrillator (n = 17), implantable cardioverter defibrillator (n = 11), and pacemaker (n = 8) devices. The overall positive FISHseq detection rate was 97%. Intraoperatively, pathogens were isolated in 42 vs. 53% in standard cultivation vs. FISHseq, respectively. In 16 of 17 FISHseq-negative patients, the nucleic acid strain DAPI (4',6-diamidino-2-phenylindole) indicated inactive microorganisms, which were partially organized in biofilms (n = 4) or microcolonies (n = 2). In 13 patients in whom no pathogen was identified preoperatively, standard cultivation and FISHseq identified pathogens in 3 (23%) vs. 8 (62%), respectively. For the confirmation of preoperatively known bacteria, a combined approach was most efficient. CONCLUSION: Fluorescence in situ hybridization sequencing is a valuable tool to detect causative microorganisms in CIED infections. The combination of FISHseq with preoperative cultivation showed the highest efficacy in detecting pathogens. Additional cultivation of intraoperative tissue samples or swabs yielded more confirmation of pathogens known from preoperative culture.
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Just et al. (2022) conducted an observational in Infections of cardiac implantable electronic devices (CIEDs) (n=36). Fluorescence in situ hybridization with polymerase chain reaction and sequencing (FISHseq) vs. Standard microbiological cultivation was evaluated on Intraoperative pathogen isolation. FISHseq identified intraoperative pathogens in 53% of patients with CIED infections compared to 42% with standard cultivation, and detected pathogens in 62% vs 23% of preoperatively negative cases.