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2017 ; 12
(4
): e0175569
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New insights into valve-related intramural and intracellular bacterial diversity
in infective endocarditis
#MMPMID28410379
Oberbach A
; Schlichting N
; Feder S
; Lehmann S
; Kullnick Y
; Buschmann T
; Blumert C
; Horn F
; Neuhaus J
; Neujahr R
; Bagaev E
; Hagl C
; Pichlmaier M
; Rodloff AC
; Gräber S
; Kirsch K
; Sandri M
; Kumbhari V
; Behzadi A
; Behzadi A
; Correia JC
; Mohr FW
; Friedrich M
PLoS One
2017[]; 12
(4
): e0175569
PMID28410379
show ga
AIMS: In infective endocarditis (IE), a severe inflammatory disease of the
endocardium with an unchanged incidence and mortality rate over the past decades,
only 1% of the cases have been described as polymicrobial infections based on
microbiological approaches. The aim of this study was to identify potential
biodiversity of bacterial species from infected native and prosthetic valves.
Furthermore, we compared the ultrastructural micro-environments to detect the
localization and distribution patterns of pathogens in IE. MATERIAL AND METHODS:
Using next-generation sequencing (NGS) of 16S rDNA, which allows analysis of the
entire bacterial community within a single sample, we investigated the
biodiversity of infectious bacterial species from resected native and prosthetic
valves in a clinical cohort of 8 IE patients. Furthermore, we investigated the
ultrastructural infected valve micro-environment by focused ion beam scanning
electron microscopy (FIB-SEM). RESULTS: Biodiversity was detected in 7 of 8
resected heart valves. This comprised 13 bacterial genera and 16 species. In
addition to 11 pathogens already described as being IE related, 5 bacterial
species were identified as having a novel association. In contrast, valve and
blood culture-based diagnosis revealed only 4 species from 3 bacterial genera and
did not show any relevant antibiotic resistance. The antibiotics chosen on this
basis for treatment, however, did not cover the bacterial spectra identified by
our amplicon sequencing analysis in 4 of 8 cases. In addition to intramural
distribution patterns of infective bacteria, intracellular localization with
evidence of bacterial immune escape mechanisms was identified. CONCLUSION: The
high frequency of polymicrobial infections, pathogen diversity, and intracellular
persistence of common IE-causing bacteria may provide clues to help explain the
persistent and devastating mortality rate observed for IE. Improved bacterial
diagnosis by 16S rDNA NGS that increases the ability to tailor antibiotic therapy
may result in improved outcomes.
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