Proof of Concept Evaluation of a New Diagnostic POCT Device for Culture- Independent Microbiological Diagnosis of Infective Endocarditis

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/nƚƌŽĚƵĐƟŽn: Accurate and fast microbiological diagnosis of ŝnĨĞcÆŸvÄž ÄžnĚŽcÄ‚rĚŝƟƐ (IE) is of vital importance for ƉĂƟĞnÆš outcome. Material & Methods: Forty cƵůƚƵrĞͲnĞŐĂƟvÄž heart valves were evaluated with a new POCT mƵůƟƉůĞxͲWCZ cartridge (Unyvero™, CƵrĞƟƐ AG, Holzgerlingen, Germany), Ä‚ÄšvÄžrƟƐĞĚ to detect several Gram ƉŽƐŝƟvĞͬnĞŐĂƟvÄž bacteria and fungi, together with several Ä‚nÆŸbŝŽƟc resistance genes. Those POCT results were compared to cŽnvÄžnƟŽnĂů 16S rDNA PCR/sequencing results. Results: POCT mƵůƟƉůĞxͲWCZ was ƉŽƐŝƟvÄž in 13 cases. [Staphylococcus aureus (n=5), Enterococcus spp. / E. faecalis (n=5), ConS (n=1), Granulicatella adjacens (n=1), Abiotrophia adjacens (n=1)]. nÆŸbŝŽƟc resistances were found in 44 specimens, from which 2 specimens were without any pathogen ŝĚĞnÆŸÄ®cĂƟŽn͘ 16S rDNA PCR was ƉŽƐŝƟvÄž in 20 cases. CŽnƐĞcƵƟvÄž sequencing ŝĚĞnƟĮĞĚ those as Staphylococcus spp. (n=6), Enterococcus faecalis (n=4), Streptococcus spp. (n=4), Leifsonia shinshuensis (n=1), Granulicatella elegans / G. adjacens (n=2), Abiotrophia adjacens (n=1). One case was ƉŽƐŝƟvÄž in 16S PCR without any reliable signal in sequencing. When comparing both methods, ŝĚĞnÆŸÄ®cĂƟŽn was consistent in 9 cases and divergent in other 9 cases. Discussion: This POCT cartridge is easy to integrate into the daily microbiology laboratory work ŇŽwÍ• and is less laborious than 16S sequencing PCR. For the ĂƉƉůŝcĂƟŽn in rŽƵƟnÄž IE diagnosis, the system needs to be ŽƉƟmŝnjĞĚ to include targets for viridans streptococci and HACEK group. In ĂĚĚŝƟŽnÍ• problems with invalid resistance and pathogen target ĚĞƚĞcƟŽn need to be Ä®xĞĚ by the producer. Conclusion: The analyzed POCT system might be a future ĚŝĂŐnŽƐƟc tool for IE ĚĞƚĞcƟŽn following assay ŽƉƟmŝnjĂƟŽn͘