Blood culture-negative infective endocarditis: a worse outcome? Results from a large multicentre retrospective Spanish cohort study. Issue 10 (3rd October 2021)

• Record Type: Journal Article
• Authors: Suardi, Lorenzo Roberto; de Alarcón, Arístides; García, María Victoria; Ciezar, Antonio Plata; Hidalgo Tenorio, Carmen; Martinez-Marcos, Francisco Javier; Concejo-Martínez, Elena; De la Torre Lima, Javier; Vinuesa García, David; Luque Márquez, Rafael; Ojeda, Guillermo; Reguera Iglesias, José M.; Lomas, José M.; Lopez-Cortes, Luis E.
• Is Part Of: Infectious diseases. Volume 53:Issue 10(2021)
• Page Start: 755
• Page End: 763
• Publication Date: 2021-10-03
• Subjects: Infective endocarditis -- blood cultures -- negative -- diagnosis -- mortality; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; 616.9
• DOI: 10.1080/23744235.2021.1925342
• Languages: English
• ISSNs: 2374-4235

Abstract

Abstract: Background: To assess the impact of blood cultures negative infective endocarditis (BCNIE) on in-hospital mortality. Methods: Prospective multicentre study with retrospective analysis of a Spanish cohort including adult patients with definite IE. Cardiac implantable devices infection were excluded. Comparisons between blood cultures positive and BCNIE groups were performed to analyse in-hospital mortality. Results: 1001 cases were included of which 83 (8.3%) had BCNIE. Alternative microbiological diagnosis was achieved for 39 (47%) out 83 cases. The most frequent identifications were: Coxiella burnetii (11; 28.2%), Tropheryma whipplei (4; 10.3%), Streptococcus gallolyticus (4;10.3%) and Staphylococcus epidermidis (3; 7.7%). Surgery was performed more frequently in BCNIE group (57.8 vs. 36.9%, p < .001). All-cause in-hospital mortality rate was 26.7% without statistical difference between compared groups. BCNIE was not associated to worse mortality rate in Cox regression model (aHR = 1.37, 95% CI 0.90–2.07, p = .14). Absence of microbiological diagnosis was also not associated to worse in-hospital prognosis (aHR = 1.62, 95% CI 0.99–2.64, p = .06). Conclusions: In our cohort, BCNIE was not associated to greater in-hospital mortality based in multivariate Cox regression models. The variables most frequently associated with mortality were indicated but not performed surgery (aHR = 2.48, 95% CI 1.73–3.56, p < .001), septic shock (aHR = 2.24, 95% CI 1.68–2.99, p < .001), age over 65 years (aHR = 1.88, 95% CI 1.40-2.52, p < .001) and complicated endocarditis (aHR = 1.79, 95% CI 1.36–2.37, p < .001).