Negative Blood Culture Infective Endocarditis in the Elderly: Long-Term Follow-Up

Abstract

Background and Aim: Since the appearance of transesophageal echocardiography, the long-term prognosis of patients with negative blood culture infective endocarditis (NBCIE) has been found to be similar to that of patients with positive blood culture infective endocarditis (PBCIE). Nevertheless, the prognostic implications of NBCIE in the elderly (>65 years) has not, to date, been well documented. Our aim was to study the long-term prognosis of elderly patients with NBCIE and compare it with that of elderly patients with PBCIE. Methods: Our study group was composed of 60 consecutive patients >65 years old with a diagnosis of IE (confirmed by vegetation analysis or following Duke’s criteria). Every patient underwent transthoracic and transesophageal echocardiography. Fifty patients (83.3%) had PBCIE and 10 (16.7%) had NBCIE. All patients were followed up long-term, and the study end point was a composite one of death or need for valvular heart surgery. Results: Mean age was 72.9 ± 5 years (56.7% male). Similar clinical and echocardiographic characteristics were found in both groups. Global mortality, need for surgery, predisposing factors and infection location were also similar in both groups. In addition, no differences were found in the long-term prognosis (log rank p = 0.29). Conclusions: In our series, the long-term prognosis in elderly patients with IE is independent of the presence of a negative or positive blood culture. Thus, age cannot be considered an independent risk factor of negative outcome in elderly patients with NBCIE.

2015 ESC Guidelines for the management of infective endocarditis

“…Jednak objawom tym brakuje swoistości i nie zostały włączone do aktualnych kryteriów diagnostycznych. Nietypowe objawy choroby często występują u pacjentów w podeszłym wieku oraz u osób z upośledzoną odpornością [59], u których gorączka występuje rzadziej niż u młodszych chorych. W przypadku tych pacjentów, a także innych chorych wysokiego ryzyka IZW, takich jak osoby z CHD czy sztucznymi zastawkami, należy zachować dużą czujność, podejrzewając IZW oraz nie ograniczać spektrum badań diagnostycznych umożliwiających wykluczenie IZW lub uniknięcie opóźnienia rozpoznania.…”

Indoor Navigation for a Humanoid Robot Using a View Sequence

“…3 However, these lack specificity and have not been integrated into current diagnostic criteria. 7 Atypical presentation is common in elderly or immunocompromised patients, 69 in whom fever is less frequent than in younger individuals. A high index of suspicion and low threshold for investigation to exclude IE are therefore essential in these and other high-risk groups.…”

“…372 Negative blood cultures were recently observed in 16.7% of elderly patients with IE. 69 Finally, older age has been associated with poor prognosis in the majority of recent studies. 166,372,374,375 Fewer elderly patients are treated by surgery, probably in relation to a higher operative risk related to advanced age and frequent co-morbidity.…”

Patients with infective endocarditis: Five-year observation from a single reference center

“…More and more often, the manifestation of IE is atypical, particularly in older individuals and those with immunosuppression. 12 Despite a patient's medical history and physical examination, echocardiographic and microbiological tests play an essential role in the diagnosis of IE. TTE is a first-choice test when IE is suspected.…”