Diagnosis of blood culture-negative endocarditis and clinical comparison between blood culture-negative and blood culture-positive cases

Lamas, Cristiane da Cruz; Fournier, Pierre‐Edouard; Zappa, Monica; Brandão, Tatiana J. D.; Januário-da-Silva, Carolina A.; Correia, Marcelo; Barbosa, Giovanna Ferraiuoli; Golebiovski, W.; Weksler, Clara; Lépidi, Hubert; Raoult, Didier

doi:10.1007/s15010-015-0863-x

Cited by 83 publications

(65 citation statements)

References 40 publications

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“…Compared to the literature published from China on IE, the rate approached to other studies in our region [14][15][16]. But it was signi cantly lower than that reported by other studies from developed countries with 74%-100% [26,27].However, according to the 2015 European Association of Cardiology guidelines on IE , for TTE positive patients, TEE should be performed to exclude perivalvular complications [1]. The low utilization rate of TEE could directly resulted in the low detection rate of perivalvular complications such as valvular perforation and perivalvular abscess.…”

Section: Discussioncontrasting

confidence: 75%

Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

Wu¹,

Chen

Xiao

et al. 2020

Preprint

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Background: To explore the trends in epidemiology and the risk factors related to the prognosis of infective endocarditis in a tertiary hospital over the past ten years. Methods: A retrospective cohort study was performed. A total of 407 consecutive patients who were admitted with infective endocarditis were included. The clinical characteristics and the risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 11.3%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease(17.0%) which showed a decreased trend during this period (P<0.001). There were 222(54.5%) patients with positive blood cultures results and Streptococci (24.6%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 235 patients (57.7%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.594, 95% CI 5.561-148.173) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. Conclusions: There were no significant change in the overall incidence of infective endocarditis, but the clinical features of infective endocarditis had slightly changed during the past ten years. Streptococci infective endocarditis was still the predominant. Patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome. Keywords: Infective endocarditis, epidemiology, risk factors, mortality.

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Section: Discussioncontrasting

confidence: 75%

Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

Wu¹,

Chen

Xiao

et al. 2020

Preprint

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“…Based on a review of the literature published from China on IE, the rate was similarly but it approached to other studies in our region [13,18,19]. But this rate was significantly lower than that reported by other studies from developed countries with 74%-100% [20,21].However, according to the 2015 European Association of Cardiology guidelines on IE, for TTE positive patients, TEE should be performed to exclude perivalvular complications[1]. The low utilization rate of TEE could directly resulted in the low detection rate of perivalvular complications such as valvular perforation and perivalvular abscess in our study.…”

Section: Discussionsupporting

confidence: 51%

Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

Chen

Xiao

et al. 2019

Preprint

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Background: To explore the trends in epidemiology and risk factors related to the prognosis of infective endocarditis in a teaching hospital over the past ten years. Methods: A retrospective cohort study was performed. A total of 407 consecutive patients were included. The clinical characteristics and risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 12.2%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease which showed a decreased trend during this period (P<0.001). There were 222(54.5%) positive blood cultures and streptococci (44.1%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 234 patients (57.5%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.5, 95% CI 5.5-148.1) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. Conclusions: There was no significant change in the overall incidence of IE, the clinical features of IE have changed slightly during the past ten years. Streptococci IE was still the predominant. IE patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.

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“…Gram stain of tissue processed in the microbiology laboratory may be more sensitive than histopathological Gram stain of tissue sections, 81% versus 67% in one study; however, in 10% of cases, the histopathology Gram stain detected organisms while the microbiology Gram stain was negative (17). Unfortunately, several studies have shown that culture of valve tissue suffers from low sensitivity and specificity, with positive cultures in only 6% to 26% of endocarditis cases (17,18,25). A microorganism different from that identified by blood culture or valve PCR was detected in 36% (10/28) of positive valve cultures in one study, suggesting a high rate of false positivity of valve culture (25).…”

Section: Evaluation Of Excised Cardiac Valvular Tissuementioning

confidence: 91%

“…Blood cultures are negative in 2% to 40% of cases of endocarditis, with some studies reporting blood culture-negative rates up to 71% (4,5,(17)(18)(19). The causes of so-called "culture-negative endocarditis" fall into two categories: negative blood cultures due to concomitant or antecedent antibacterial therapy or the presence of an organism that does not grow in routine blood cultures, with the first being more common.…”

Section: Diagnosis Of Culture-negative Endocarditismentioning

confidence: 99%

Laboratory Diagnosis of Infective Endocarditis

et al. 2017

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Infective endocarditis is life-threatening; identification of the underlying etiology informs optimized individual patient management. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing (i.e., Q fever serology, Bartonella serology) in culture-negative cases. Histopathology and molecular diagnostics (e.g., 16S rRNA gene PCR/sequencing, Tropheryma whipplei PCR) may be applied to resected valves to aid in diagnosis. Herein, we summarize recent knowledge in this area and propose a microbiologic and pathological algorithm for endocarditis diagnosis. KEYWORDS clinical microbiology, endocarditisD espite recent advances in diagnostic and therapeutic strategies, the mortality of infective endocarditis remains high, with more than one-third of patients affected dying within a year following diagnosis (1, 2). Identification of the specific underlying microbial etiology is essential for optimal patient management; delays in microbial diagnosis may contribute to late initiation of effective antimicrobial therapy, influencing morbidity and mortality. The modified Duke criteria provide a basic scheme for diagnosis and definition of endocarditis and rely on detection of infecting microorganisms in addition to echocardiographic and clinical findings (1, 3). The finding of two (or more) blood cultures positive for a typical microorganism consistent with infective endocarditis is a major criterion for infective endocarditis as is positive Q fever serology (anti-phase I IgG titer of Ն1:800). Echocardiographic findings are also considered but are beyond the scope of the manuscript.The epidemiology of endocarditis, which has shifted in recent years, should guide diagnostic testing. Today, staphylococci and streptococci combined cause ϳ80% of cases. Staphylococcus aureus remains the dominant pathogen, associated with ϳ25% to ϳ30% of cases, while coagulase-negative staphylococci account for ϳ11% of cases (4, 5). Streptococci, primarily viridans group streptococci, cause ϳ30% of cases, with Streptococcus gallolyticus (a Streptococcus bovis group member) being involved in ϳ20% to ϳ50% of streptococcal cases (4, 5). Enterococci, especially Enterococcus faecalis, account for ϳ10% of cases (4, 5). Gram-negative bacilli account for ϳ5% of cases and include the HACEK group organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella species) and, less commonly, non-HACEK Gramnegative bacilli, such as the Enterobacteriaceae and nonfermenting Gram-negative bacilli. Fungi are rare endocarditis causes, with Candida species being the most common. A number of uncultivable or challenging to cultivate organisms cause endocarditis, the most common of which are Coxiella burnetii, Bartonella species, and Tropheryma whipplei.Endocarditis most often involves the aortic or mitral valves, with tricuspid valve involvement accoun...

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Diagnosis of blood culture-negative endocarditis and clinical comparison between blood culture-negative and blood culture-positive cases

Abstract: BCNE resulted mostly from prior antibiotics and was associated with severe hemodynamic compromise. Valve histopathology and PCR were useful in confirming the diagnosis and pointing to the etiology of BCNE.

Cited by 83 publications

References 40 publications

Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

Laboratory Diagnosis of Infective Endocarditis

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