Current Issues in the Diagnosis and Management of Blood Culture-Negative Infective and Non-Infective Endocarditis

Objective: This study aimed to identify possible differences between blood culture-negative and blood culture-positive groups of infective endocarditis (IE), and explore the associations between biological parameters and in-hospital mortality. Methods: This was a retrospective study of patients hospitalized for IE between 2007 and 2017. Epidemiological, clinical and paraclinical characteristics, by blood culture-negative and positive groups, were collected. The best predictors of in-hospital mortality based on the receiver-operating characteristic (ROC) analysis and AUC (area under the curve) results were identified. Results: A total of 126 IE patients were included, 54% with negative blood cultures at admission. Overall, the in-hospital mortality was 28.6%, higher in the blood culture-negative than positive group (17.5% vs. 11.1%, p = 0.207). A significant increase in the Model for End-Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) score was observed in the blood culture-negative group (p = 0.004), but no baseline characteristics differed between the groups. The best laboratory predictors of in-hospital death in the total study group were the neutrophil count (AUC = 0.824), white blood cell count (AUC = 0.724) and MELD-XI score (AUC = 0.700). Conclusion: Classic laboratory parameters, such as the white blood cell count and neutrophil count, were associated with in-hospital mortality in infective endocarditis. In addition, MELD-XI was a good predictor of in-hospital death.

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Corrigendum to: Blood culture negative infective endocarditis in adult congenital heart disease patients with prosthetic grafts: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab272 ◽

2021 ◽

Vol 5 (8) ◽

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Infective Endocarditis ◽

Blood Culture ◽

Congenital Heart ◽

Adult Congenital Heart Disease ◽

Case Series ◽

Adult Congenital ◽

Culture Negative

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Comparison of outcome between blood culture positive and negative infective endocarditis patients undergoing cardiac surgery

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01532-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Kristians Meidrops ◽

Arina Zuravlova ◽

Janis Davis Osipovs ◽

Martins Kalejs ◽

Valerija Groma ◽

...

Keyword(s):

Cardiac Surgery ◽

Infective Endocarditis ◽

Blood Culture ◽

Multivariate Analyses ◽

Statistical Significance ◽

Delayed Diagnosis ◽

Causative Microorganism ◽

Independent Association ◽

Culture Positive ◽

Culture Negative

Abstract Background Up to 30% or even more of all infective endocarditis (IE) cases are recognized as blood culture negative, meaning that the causative agent is left unidentified. The prompt diagnosis together with the identification of causative microorganism and targeted antibiotic treatment can significantly impact the prognosis of the disease and further patient’s health status. In some studies, blood culture negative endocarditis has been shown to be associated with delayed diagnosis, worse outcome and course of the disease, and a greater number of intra and postoperative complications. Methods We retrospectively analysed the medical records of all patients who underwent cardiac surgery for endocarditis between years 2016 and 2019. The aim of this study was to analyse short and long-term mortality and differences of laboratory, clinical and echocardiography parameters in patients with blood culture positive endocarditis (BCPE) and blood culture negative endocarditis (BCNE) and its possible impact on the clinical outcome. Results In our study population were 114 (55.1%) blood culture positive and 93 (44.9%) blood culture negative cases of infectious endocarditis. The most common pathogens in the blood culture positive IE group were S.aureus in 36 cases (31.6%), Streptococcus spp. in 27 (23.7%), E.faecalis in 24 (21.1%), and other microorganisms in 27 (23.7%). Embolic events were seen in 60 patients (28.9%). In univariate analyses, detection of microorganism, elevated levels of procalcitonin were found to be significantly associated with intrahospital death, however it did not reach statistical significance in multivariate analyses. Among microorganisms, S.aureus was significantly associated with intrahospital death in both univariate and multivariate analyses. Conclusions There are no statistically significant differences between groups of BCPE and BCNE in terms of intrahospital mortality, hospital and ICU stay or 3-year mortality. There were higher levels of procalcitonin in BCPE group, however procalcitonin failed to show independent association with mortality in multivariate analysis. The most common microorganism in the BCPE group was S.aureus. It was associated with independently higher intrahospital mortality when compared to other causative microorganisms.

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Factors Affecting Mortality in Patients with Blood-Culture Negative Infective Endocarditis

International Journal of Angiology ◽

10.1055/s-0039-3402744 ◽

2020 ◽

Vol 29 (01) ◽

pp. 012-018

Author(s):

Lira Firiana ◽

Bambang Budi Siswanto ◽

Emir Yonas ◽

Radityo Prakoso ◽

Raymond Pranata

Keyword(s):

Heart Failure ◽

Infective Endocarditis ◽

Blood Culture ◽

Risk Stratification ◽

Hospital Mortality ◽

Kidney Function ◽

Functional Class ◽

Class Iii ◽

Nyha Functional Class ◽

Culture Negative

AbstractInfective endocarditis retains high morbidity and mortality rates despite recent advances in diagnostics, pharmacotherapy, and surgical intervention. Risk stratification in endocarditis patients, including blood-culture negative endocarditis, is crucial in deciding the optimal management strategy; however, the studies investigating risk stratification in these patients were lacking despite the difference with blood-culture positive endocarditis. The aim of this study is to identify risk factors associated with in-hospital mortality in blood-culture negative infective endocarditis patients. A retrospective cohort study was conducted at National Cardiovascular Center Harapan Kita, Jakarta in blood-culture negative infective endocarditis patients from 2013 to 2015. Patient characteristics, clinical parameters, echocardiographic parameters, and clinical complications were collected from medical records and hospital information systems. There were 146 patients that satisfy the inclusion and exclusion criteria out of 162 patients with blood-culture infective endocarditis. The in-hospital mortality rate was 13.5%. On bivariate analyses, factors that were related to in-hospital mortality include New York Heart Association (NYHA) class III and IV heart failure (p = 0.007), history of hypertension (p = 0.021), stroke during hospitalization (p < 0.001), the decline in renal function (p < 0.001), and surgery (p = 0.028). Variables that were independently associated with mortality upon multivariate analysis were heart failure NYHA functional class III and IV (OR 7.56, p = 0.011), worsening kidney function (OR 10.23, p < 0.001), and stroke during hospitalization (OR 8.92, p = 0.001). Presence of heart failure with NYHA functional class III and IV, worsening kidney function, and stroke during hospitalization were independently associated with in-hospital mortality in blood-culture infective endocarditis patients.

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Aortic valve cusp aneurysm as a result of blood culture‐negative infective endocarditis, interesting echocardiographic and surgical images

Echocardiography ◽

10.1111/echo.14609 ◽

2020 ◽

Vol 37 (3) ◽

pp. 469-471 ◽

Cited By ~ 1

Author(s):

Shokoufeh Hajsadeghi ◽

Mahboubeh Pazoki ◽

Marziyeh Pakbaz ◽

Sam Zeraatian ◽

Mohammad Amin Zaeim

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Blood Culture ◽

Culture Negative

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Blood Culture-Negative but Clinically Diagnosed Infective Endocarditis Complicated by Intracranial Mycotic Aneurysm, Brain Abscess, and Posterior Tibial Artery Pseudoaneurysm

Case Reports in Neurological Medicine ◽

10.1155/2018/1236502 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Chao Jiang ◽

Haibin Lu ◽

Yaoqiang Guo ◽

Li Zhu ◽

Tianqi Luo ◽

...

Keyword(s):

Infective Endocarditis ◽

Blood Culture ◽

Brain Abscess ◽

Mycotic Aneurysm ◽

Artery Aneurysm ◽

Posterior Tibial Artery ◽

Artery Pseudoaneurysm ◽

Posterior Tibial ◽

Tibial Artery ◽

Culture Negative

Blood culture-negative endocarditis is often severe and difficult to diagnose. It is necessary to emphasize the importance for the early diagnosis and accurate treatment of blood culture-negative endocarditis. Here, we described the relevant clinical information of a blood culture-negative but clinically diagnosed infective endocarditis complicated by intracranial mycotic aneurysm, brain abscess, and posterior tibial artery pseudoaneurysm. This patient was a 65-year-old man with a 9-month history of intermittent fever and died in the end for the progressive neurological deterioration. Although the blood culture is negative, this patient was clinically diagnosed as infective endocarditis according to Duke criteria. This patient course was complicated not only by cerebral embolism, intracranial mycotic aneurysm, and brain abscess but also by posterior tibial artery aneurysm of the lower extremity. The clinical findings of this patient suggest that the confirmatory microbiology is essential for the treatment of blood culture-negative infective endocarditis. Clinicians should be aware of the detriment of blood culture-negative infective endocarditis for its multiple complications may occur in one patient. The delayed etiological diagnosis and insufficient treatment may aggregate the clinical outcome of blood culture-negative infective endocarditis.

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