Infective endocarditis: Absence of microbiological diagnosis is an independent predictor of inhospital mortality

Díez‐Villanueva, Pablo; Muñóz, Patricia; Marı́n, Mercedes; Bermejo, Javier; González, Arístides de Alarcón; Fariñas, María Carmen; Gutiérrez‐Cuadra, Manuel; Pericás-Pulido, Jose Manuel; Lepe, José Antonio; Corral, Laura Castelo; Goenaga, Miguel Ángel; Ruíz-Morales, Josefa; Tarabini, Paola; Martínez‐Sellés, Manuel

doi:10.1016/j.ijcard.2016.06.129

Cited by 29 publications

(24 citation statements)

References 28 publications

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“…The study by Zamorano et al showed that CNIE had a higher frequency of heart failure and valve rupture or perforation, as well as a tendency to more frequent need of surgical repair, although mortality was not different than CPIE [2]. Conversely, Diez-Villanueva et al found CNIE to be an independent predictor of early mortality and postoperative heart failure [5]. As specifically regards surgically treated IE, in the study of Murashita et al, CNIE was an independent predictor of poor late survival and increased rate of postoperative adverse events, but it was not associated with early mortality [3].…”

Section: Discussionmentioning

confidence: 98%

“…Failure to culture the causative agent (e.g., because of antimicrobial treatment prior to blood culture and/or infection with hardly detectable pathogens) has been associated with increased mortality in IE patients, both in medically and in surgically treated patients, although only a few analyses that clearly separate medical and surgical cohorts have been conducted [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Culture-negative infective endocarditis (CNIE): impact on postoperative mortality

et al. 2020

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AbstractIntroductionPoor postoperative outcomes have been reported after surgery for infective endocarditis (IE). Whether the absence of positive cultures impacts the prognosis remains a matter of discussion. The aim of this study was to evaluate the impact of negative cultures on the prognosis of surgically treated IE.MethodsThis was a single-center, retrospective study. From January 2000 to June 2019, all patients who underwent valvular surgery for IE were included in the study. The primary endpoint was early postoperative mortality. A covariate balancing propensity score was developed to minimize the differences between the culture-positive IE (CPIE) and culture-negative IE (CNIE) cohorts. Using the estimated propensity scores as weights, an inverse probability treatment weighting (IPTW) model was built to generate a weighted cohort. Then, to adjust for confounding related to CPIE and CNIE, a doubly robust method that combines regression model with IPTW by propensity score was adopted to estimate the causal effect of the exposure on the outcome.ResultsDuring the study period, 327 consecutive patients underwent valvular repair/replacement with the use of cardiopulmonary bypass and cardioplegic cardiac arrest for IE. Their mean age was 61.4 ± 15.4 years, and 246 were males (75.2%). Native valve IE and prosthetic valve IE accounted for 87.5% and 12.5% of cases, respectively. Aortic (182/327, 55.7%) and mitral valves (166/327, 50.8%) were mostly involved; 20.5% of isolated mitral valve diseases were repaired (22/107 patients). The tricuspid valve was involved in 10 patients (3.3%), and the pulmonary valve in 1 patient (<1%). Fifty-nine patients had multiple-valve disease (18.0%). Blood cultures were negative in 136/327 (41.6 %). A higher postoperative mortality was registered in CNIE than in CPIE patients (19% vs 9%, respectively, p = 0.01). The doubly robust analysis after IPTW by propensity score showed CNIE to be associated with early postoperative mortality (odds ratio 2.10; 95% CI, 1.04–4.26, p = 0.04).ConclusionsIn our cohort, CNIE was associated with a higher early postoperative mortality in surgically treated IE patients after dedicated adjustment for confounding. In this perspective, any effort to improve preoperative microbiological diagnosis, thus allowing targeted therapeutic initiatives, might lead to overall better postoperative outcomes in surgically treated IE.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Culture-negative infective endocarditis (CNIE): impact on postoperative mortality

et al. 2020

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“…Establishing an IE diagnosis is a complex, multi-disciplinary process. Delayed diagnosis and treatment can lead to complications and worse clinical outcomes [ 18 – 22 ]. Due to the fact that 1-year mortality from IE has not improved in over two decades, it is crucial to develop more accurate diagnostic tools [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

99mTc-HMPAO-labeled leukocyte SPECT/CT and transthoracic echocardiography diagnostic value in infective endocarditis

Holcman

Szot

Rubiś

et al. 2018

Int J Cardiovasc Imaging

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Infective endocarditis (IE) is a life-threatening disease, establishing a diagnosis is often challenging. The aim of this prospective study was to evaluate and compare the diagnostic performance of the combined use of single photon emission tomography and computed tomography with technetium99m-hexamethylpropyleneamineoxime—labeled leukocytes (99mTc-HMPAO-SPECT/CT) with transthoracic echocardiography (TTE) in patients with suspected IE. We enrolled 40 consecutive patients (12 females, 28 males, mean age: 58.6 ± 18) with suspected IE in the years 2015–2016. All patients underwent clinical evaluation, TTE and 99mTc-HMPAO-SPECT/CT for the assessment of lesions typical for IE. Scans were evaluated for the presence and location of increased radioactivity foci, corresponding to the accumulation of radiolabeled leukocytes in inflammatory lesions. After 6 months, the patients were re-evaluated clinically and with TTE. Final IE diagnosis was established in 14 (35%) patients. Lesions typical for IE were shown in 28 (70%) TTEs and 16 (40%) 99mTc-HMPAO-SPECT/CTs. The latter tests were characterized by 90% accuracy, 93% sensitivity, 88% specificity, 96% negative predictive value (NPV), 81% positive predictive value (PPV). TTE demonstrated 60% accuracy, 93% sensitivity, 42% specificity, 92% NPV, and 46% PPV. 99mTc-HMPAO-SPECT/CT was characterized by a lower number of false-positive results compared to TTE (3 vs. 15). In patients with suspected IE, 99mTc-HMPAO-SPECT/CT yields a smaller number of false-positive results, significantly higher diagnostic accuracy, specificity and PPV than TTE. It helps to differentiate IE infectious and sterile echocardiographic lesions and reduces by 27% the number of misdiagnosed IE classified in the ‘possible IE’ category by modified Duke Criteria.

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“…BCNE is a relative frequent condition among endocarditis representing 5-30% in big series [67][68][69][70]. The main reasons are the previous administration of antimicrobials and fastidiously culture microorganisms [67,68,[71][72][73][74][75]. The application of molecular tools has allowed doing new approximations to the etiology of BCNE and new agents have been involved [69].…”

Section: Epidemiologymentioning

confidence: 99%

Tropheryma whippleiEndocarditis

García‐Álvarez¹,

Oteo²

2021

Advanced Concepts in Endocarditis - 2021

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Tropheryma whipplei mainly known as the causative agent of classical Whipple’s disease, also produces acute, sub-acute and chronic localized forms of infection such as endocarditis. The development of molecular tools has allowed increasing the number of cases of endocarditis due to blood culture use to be negative in T. whipplei endocarditis and most of the cases are confirmed post-surgery when molecular analyses of heart valves are performed. Although, T. whipplei endocarditis is an uncommon condition with an atypical presentation it must be considered in the diagnosis of blood culture negative endocarditis and in patients with heart failure in which valve affectation is present. Other clinical features such as long lasting arthralgia can be present in a high percentage of the patients. It is important to know that few cases are diagnosed in the context of the classical Whipple’s disease. The prognosis is very good when an appropriate surgical management and antimicrobial-specific treatment is given. This chapter describes the epidemiological, clinical characteristics, diagnosis and treatments for T. whipplei endocarditis.

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Infective endocarditis: Absence of microbiological diagnosis is an independent predictor of inhospital mortality

Cited by 29 publications

References 28 publications

Culture-negative infective endocarditis (CNIE): impact on postoperative mortality

Culture-negative infective endocarditis (CNIE): impact on postoperative mortality

99mTc-HMPAO-labeled leukocyte SPECT/CT and transthoracic echocardiography diagnostic value in infective endocarditis

Tropheryma whippleiEndocarditis

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