Surgical results for active endocarditis with prosthetic valve replacement: impact of culture-negative endocarditis on early and late outcomes

Murashita, Takashi; Sugiki, Hiroshi; Kamikubo, Yasuhiro; Yasuda, Keishu

doi:10.1016/j.ejcts.2004.08.007

Cited by 56 publications

(34 citation statements)

References 23 publications

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“…The present study, consistently with a number of previous analyses [12–15], showed that 2 out of the 6 most significant independent predictors of postoperative death in 440 endocarditis surgery patients were specific of the IE setting, that is, microbiology- or infection-related, and not included in the most commonly employed prognostic systems. …”

Section: Discussionsupporting

confidence: 89%

The Need for a Specific Risk Prediction System in Native Valve Infective Endocarditis Surgery

Feo

Cotrufo²,

Carozza³

et al. 2012

The Scientific World Journal

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The need for a specific risk score system for infective endocarditis (IE) surgery has been previously claimed. In a single-center pilot study, preliminary to future multicentric development and validation, bivariate and multivariate (logistic regression) analysis of early postoperative mortality predictors in 440 native valve IE patients were performed. Mathematical procedures assigned scores to the independent predictors emerged (AUC of the ROC curve: 0.88). Overall mortality was 9.1%. Six predictors were identified and assigned scores, including age (5–13 points), renal failure (5), NYHA class IV (9), critical preoperative state (11), lack of preoperative attainment of blood culture negativity (5), perivalvular involvement (5). Four risk classes were drawn ranging from “very low risk” (≤5 points, mean predicted mortality 1%), and to “very high risk” (≥20 points, 43% mortality). IE-specific risk stratification models are both needed, as disease-specific factors (e.g., cultures, abscess), beside the generic ones (e.g., age, renal impairment) affect mortality, and feasible.

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Section: Discussionsupporting

confidence: 89%

The Need for a Specific Risk Prediction System in Native Valve Infective Endocarditis Surgery

Feo

Cotrufo²,

Carozza³

et al. 2012

The Scientific World Journal

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“…However, blood cultures remain negative in 14–30%1–5 11 25 of cases often delaying the initiation of treatment, with a potential profound impact on clinical outcome 26 27. In a study of patients undergoing surgical treatment for IE, negative blood cultures were independently associated with an adverse outcome after surgery 28 29. Negative blood cultures are, therefore, of considerable concern in the management of these patients, and may result from inadequate microbiological techniques, infection with highly fastidious bacteria or non-bacterial pathogens, or the earlier administration of antimicrobial agents before blood cultures were obtained 12.…”

Section: Discussionmentioning

confidence: 99%

Investigation of blood culture-negative early prosthetic valve endocarditis reveals high prevalence of fungi

Thuny

Fournier

Casalta

et al. 2009

Heart

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Context Early prosthetic valve endocarditis is a deadly disease and blood cultures remain negative in 14-30% of cases. Objectives To analyse the clinical and microbiological profile of patients with blood culture-negative (BCN) early prosthetic valve endocarditis (PVE) in order to define the most appropriate empiric treatment. Design, Setting and Participants From June 2001 to February 2009, a prospective multimodal strategy incorporating serological, molecular and histopathological assays was performed in all the samples referred to the laboratory for a suspicion of blood culture-negative endocarditis (BCNE) from France and abroad (n=718). A total of 31 patients with BCN early PVE was identified. Their microbiological profile was compared with that of 22 patients with blood culture-positive (BCP) early PVE and 628 patients with community-acquired BCNE identified during the same period. Results A pathogen was identified in 10 patients (32%) with BCN early PVE. Fungi were the most common pathogens identified, being found in 16% versus 4.5% in the case of PBC early PVE and 0.5% in community-acquired BCNE (p<0.001). The global microbiological profile of BCN early PVE differed strongly from that of PBC early PVE and community-acquired BCNE. A higher rate of microbiological diagnosis was obtained in patients who underwent surgery (9/21 (43%) vs 1/10 (10%), p=0.07) and an increased rate of recurrences was observed when a pathogen could not be identified (9/21 (43%) vs 1/10 (10%), p=0.07). Conclusions BCN early PVE exhibits specific aetiologies as fungi are the most frequent pathogens identified. Therefore, fungi should be investigated particularly by molecular methods on surgical specimens and an antifungal drug might be added to the empiric treatment.

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“…In a study of patients post-surgery, multivariate analysis of variables influencing events (death, peri-prosthetic leakage, re-operation and recurrence of infection) identified those patients with negative blood cultures as significantly more likely to suffer an adverse outcome after surgery compared with those patients where a pathogen had been identified (52.4% vs. 19.6%, P < 0.05) [10]. Negative blood cultures are, therefore, of considerable concern in the management of IE patients.…”

Section: Introductionmentioning

confidence: 97%

Infective endocarditis with negative blood cultures

Naber

Erbel

2007

International Journal of Antimicrobial Agents

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Surgical results for active endocarditis with prosthetic valve replacement: impact of culture-negative endocarditis on early and late outcomes

Cited by 56 publications

References 23 publications

The Need for a Specific Risk Prediction System in Native Valve Infective Endocarditis Surgery

The Need for a Specific Risk Prediction System in Native Valve Infective Endocarditis Surgery

Investigation of blood culture-negative early prosthetic valve endocarditis reveals high prevalence of fungi

Infective endocarditis with negative blood cultures

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