Community-acquired culture-negative endocarditis: clinical characteristics and risk factors for mortality

Abstract

Culture-negative endocarditis patients presented with lower levels of C-reactive protein at admission and required more time for initiation of antibiotic therapy, although there was no difference in in-hospital mortality or long-term survival between culture-negative and culture-positive endocarditis patients. Diabetes mellitus and severe sepsis were associated with in-hospital death in patients with culture-negative endocarditis.

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

“…3,9 A study by Siciliano et al specifically reported mortality predictor in IE negative-culture patients, albeit with relatively fewer samples (51 cases in 9 years [1991][1992][1993][1994][1995][1996][1997][1998][1999]) compared with 146 cases in 5 years of this study. 2 This study differs from the other study in several aspects, namely risk factor definition population characteristics, sample size, and the novel inclusion of tricuspid annular plane systolic excursion as a mortality predictor. This new risk factor definition includes evaluation of acute kidney injury within the course of treatment, using criteria defined by the acute kidney injury network.…”

“…Even with numerous studies on factors related to mortality in this condition, caveats exist due to different patients characteristics between the centers of study. 2,3,9 Furthermore, factors that are reported to be related to worse outcomes in one study often are not statistically significant across other studies. This study evaluates factors that are related to in-hospital mortality BCNIE patients at Harapan Kita National Cardiovascular Center, a tertiary hospital for heart and vascular disorders.…”

“…These proportions are still relatively high compared with that of Brazil which ranges at 23%. 2,12,13 Mirabel et al at Laos reported a proportion of BCNIE patients at 61.1%, 12 while Watt et al in Thailand reported an incidence of BCNIE at 69%. 13,14 Further microbiologic studies using serology and polymerase chain reaction (PCR) have not been routinely implemented in Harapan Kita National Cardiovascular Center, which poses a challenge in investigating causal microorganism in BCNIE at our institution.…”

“…The mortality rate in BCNIE patients ranged from 2.5 to 31.4%. 1,2 There were no national data on the epidemiology of both IE and BCNIE at the time this article was written; in National Cardiovascular Center Harapan Kita (NCCHK) the total of IE patients in the last 5 years (2013-2017) were 283 patients.…”

“…5 Patients with BCNIE were associated with worse prognosis, including a higher rate of heart failure and valve perforation compared to those with positive blood culture. 2,6 Risk stratification in IE patients, including BCNIE, is crucial in deciding the optimal management strategy to lower the rate of mortality and morbidity in these patients. However, the studies investigating risk stratification in BCNIE patients were lacking.…”