Microbiological Diagnosis in Cardiac Implantable Electronic Device Infections Detected by Sonication and Next-Generation Sequencing

Thomas Olsen; Ulrik Stenz Justesen; Jens Cosedis Nielsen; Ole Dan Jørgensen; Niels Christian Foldager Sandgaard; Christen Ravn; Christian Gerdes; Anna Margrethe Thøgersen; Sabine Gill; Kurt Fuursted; Jens Brock Johansen

doi:10.1016/j.hrthm.2022.01.039

Microbiological Diagnosis in Cardiac Implantable Electronic Device Infections Detected by Sonication and Next-Generation Sequencing

Thomas Olsen^*, Ulrik Stenz Justesen, Jens Cosedis Nielsen, Ole Dan Jørgensen, Niels Christian Foldager Sandgaard, Christen Ravn, Christian Gerdes, Anna Margrethe Thøgersen, Sabine Gill, Kurt Fuursted, Jens Brock Johansen

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

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.

Original language	English
Journal	Scandinavian Journal of Gastroenterology
Volume	19
Issue number	6
Pages (from-to)	901-908
Number of pages	8
ISSN	0036-5521
DOIs	https://doi.org/10.1016/j.hrthm.2022.01.039
Publication status	Published - 1 Jun 2022

Bibliographical note

Keywords

Cardiac implantable electronic device
Cardiac implantable electronic device infection
Device-related infection
Infection
Molecular microbiology
Next-generation sequencing
Sonication

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10.1016/j.hrthm.2022.01.039Licence: CC BY-NC-ND 4.0

Olsen et al. (2022). Microbiological diagnosis in cardiac implantable electronic device infections detected by sonication and next-generation sequencingFinal published version, 1.47 MBLicence: CC BY-NC-ND 4.0

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Olsen, T., Justesen, U. S., Nielsen, J. C., Jørgensen, O. D., Sandgaard, N. C. F., Ravn, C., Gerdes, C., Thøgersen, A. M., Gill, S., Fuursted, K., & Johansen, J. B. (2022). Microbiological Diagnosis in Cardiac Implantable Electronic Device Infections Detected by Sonication and Next-Generation Sequencing. Scandinavian Journal of Gastroenterology, 19(6), 901-908. Advance online publication. https://doi.org/10.1016/j.hrthm.2022.01.039

@article{596d0cada6734013a6c012bede8e25fd,

title = "Microbiological Diagnosis in Cardiac Implantable Electronic Device Infections Detected by Sonication and Next-Generation Sequencing",

abstract = "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.",

keywords = "Cardiac implantable electronic device, Cardiac implantable electronic device infection, Device-related infection, Infection, Molecular microbiology, Next-generation sequencing, Sonication",

author = "Thomas Olsen and Justesen, {Ulrik Stenz} and Nielsen, {Jens Cosedis} and J{\o}rgensen, {Ole Dan} and Sandgaard, {Niels Christian Foldager} and Christen Ravn and Christian Gerdes and Th{\o}gersen, {Anna Margrethe} and Sabine Gill and Kurt Fuursted and Johansen, {Jens Brock}",

year = "2022",

month = jun,

day = "1",

doi = "10.1016/j.hrthm.2022.01.039",

language = "English",

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pages = "901--908",

journal = "Scandinavian Journal of Gastroenterology",

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Olsen, T, Justesen, US, Nielsen, JC, Jørgensen, OD, Sandgaard, NCF, Ravn, C, Gerdes, C, Thøgersen, AM, Gill, S, Fuursted, K & Johansen, JB 2022, 'Microbiological Diagnosis in Cardiac Implantable Electronic Device Infections Detected by Sonication and Next-Generation Sequencing', Scandinavian Journal of Gastroenterology, vol. 19, no. 6, pp. 901-908. https://doi.org/10.1016/j.hrthm.2022.01.039

Microbiological Diagnosis in Cardiac Implantable Electronic Device Infections Detected by Sonication and Next-Generation Sequencing. / Olsen, Thomas; Justesen, Ulrik Stenz; Nielsen, Jens Cosedis et al.
In: Scandinavian Journal of Gastroenterology, Vol. 19, No. 6, 01.06.2022, p. 901-908.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - Microbiological Diagnosis in Cardiac Implantable Electronic Device Infections Detected by Sonication and Next-Generation Sequencing

AU - Olsen, Thomas

AU - Justesen, Ulrik Stenz

AU - Nielsen, Jens Cosedis

AU - Jørgensen, Ole Dan

AU - Sandgaard, Niels Christian Foldager

AU - Ravn, Christen

AU - Gerdes, Christian

AU - Thøgersen, Anna Margrethe

AU - Gill, Sabine

AU - Fuursted, Kurt

AU - Johansen, Jens Brock

PY - 2022/6/1

Y1 - 2022/6/1

N2 - 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.

AB - 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.

KW - Cardiac implantable electronic device

KW - Cardiac implantable electronic device infection

KW - Device-related infection

KW - Infection

KW - Molecular microbiology

KW - Next-generation sequencing

KW - Sonication

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U2 - 10.1016/j.hrthm.2022.01.039

DO - 10.1016/j.hrthm.2022.01.039

M3 - Journal article

C2 - 35124230

SN - 0036-5521

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SP - 901

EP - 908

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

IS - 6

ER -

Microbiological Diagnosis in Cardiac Implantable Electronic Device Infections Detected by Sonication and Next-Generation Sequencing

Abstract

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