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

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.

Clinical analysis of distribution and drug resistance of pathogenic bacteria in blood culture of Dalian Municipal Central Hospital from 2015 to 2019

“…G-positive cocci were the main positive strains, contrary to the results of Mao S et al 11 , which may be related to the difference in specimen quantity, geographical location, and living habits. However, the results of this study were similar to Meidrops K et al 12 , which may be related to the difference in the distribution of pathogenic bacteria in different departments.…”

In-hospital outcomes of patients undergoing emergent surgical treatment in patients with infective endocarditis

“…Meidrops et al compared the outcome between BCPE and BCNE patients undergoing cardiac surgery and the detection of microorganism was found to be significantly associated with intrahospital death in univariate analyses; however, it did not reach statistical significance in multivariate analyses. [ 15 ] In the study of De Feo et al, relationship was observed between blood culture positivity and post-operative in-hospital mortality. Moreover, lack of pre-operative attainment of blood culture negativity was defined as a parameter in the risk-scoring system.…”

Case series of 12 Bartonella quintana endocarditis from the Southwest Indian Ocean

“…BCNE is associated with a higher rate of in-hospital adverse events than blood culture-positive endocarditis, although recent publications have suggested similar long-term outcomes [ 60 ]. Two patients developed postoperative mediastinitis.…”