The Application Value Of Next Generation Sequencing In Detecting Pathogens From Heart Valves Of Patients With Infective Endocarditis

Infectious endocarditis(IE)is a common infectious disease with high mortality and serious complications.The clinical diagnosis of IE mainly depend on blood culture and its treatment rely on the drug sensitivity data provided by the positive culture results.However,the use of antibiotics before culture,some of the IE pathogens are fastidious bacteria and intracellular bacteria,which lead to the low positive rate and long culture period of traditional culture methods.Metagenomic next-generation sequencing(mNGS)is a new generation of sequencing technology with high sensitivity,high throughput and short detection period.It can simultaneously detect mixed infections of bacteria,fungi,viruses and parasites.mNGS can directly detect pathogens in samples,which can bypass the traditional culture process and overcome the shortcomings of low positive rate and long culture cycle of traditional culture methods.At present,there are many reports about the detection of pathogens in human body fluids by mNGS technology,but few reports about its application in IE diagnosis.This study aim to evaluate the value of mNGS in detecting pathogens in heart valves of IE patients,and to provide assistance for the diagnosis and treatment of IE.According to the modified Duke criterion,we used mNGS technique to detect the pathogens in the valve tissue of 20 definite IE and 7 rejected IE patients.The results were compared with those of blood culture,valve culture and pathological Gram staining.Our study showed that NGS displayed sensitivity,specificity,positive predictive values and negative predictive values of 95.0%,85.7%,95.0%,and 85.7%compared with 30.0%,100%,100%,and 30.0%for blood culture and 10.0%,100%,100%,and 28.0%for valve culture,and 77.8%,100%,100%,and 63.6%for pathological Gram staining,respectively.We conclude that compared with traditional culture methods,mNGS has higher sensitivity and shorter turnover time in detecting pathogens of IE.mNGS is of great value in the diagnosis of IE,especially in the diagnosis of suspected IE with negative culture results and in the formulation of antimicrobial plans for preventing recurrence after operation.