Key result
A diagnostic strategy including sonication and next-generation sequencing identified the causative pathogen in 95% of cardiac implantable electronic device infections.
Why the study?
Device-related infection is a severe complication of cardiac implantable electronic devices, but conventional microbiological methods to identify causative pathogens often prove inadequate.
Does a diagnostic strategy including sonication and next-generation sequencing improve the identification of causative pathogens in patients with cardiac implantable electronic device infections?
Observational (n=110)
Yes
Does a diagnostic strategy including sonication and next-generation sequencing improve the identification of causative pathogens in patients with cardiac implantable electronic device infections?
A diagnostic strategy incorporating sonication and next-generation sequencing identifies the causative pathogen in 95% of cardiac implantable electronic device infections, optimizing targeted treatment.
May aid pathogen identification in CIED infections; leaves open the need for prospective outcome validation before adoption.
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.
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Olsen et al. (2022) conducted an observational in Cardiac implantable electronic device infections (n=110). Sonication and next-generation sequencing vs. Conventional culturing was evaluated on Identification of causative pathogens. A diagnostic strategy including sonication and next-generation sequencing identified the causative pathogen in 95% of cardiac implantable electronic device infections.
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