Clinical Diagnosis and Surgical Therapy for Blood Culture-Negative Infective Endocarditis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Jianguo , SONG Laichun , TAO Liang , CHEN Xufa.

Department of Cardiac Surgery，Wuhan Asia Heart Hospital，WuHan 430002，P. R. China;;
Email：979638260@qq. com;

Corresponding author：

Keywords：

Infective endocarditis; 　Blood culture-negative; 　Direct-vision intracardiac surgery

DOI：

10.7507/1007-4848.20130208

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Objective To investigate clinical diagnosis，timing of surgery and perioperative therapeutic strategies for blood culture-negative infective endocarditis （IE）. Methods Clinical data of 240 IE patients who were admitted tWuhan Asia Heart Hospital between July 2008 and July 2012 were retrospectively analyzed. According to their blood cultureresults，all the patients were divided into blood culture-negative group and blood culture-positive group. In the blood culture-negative group，there were 158 patients including 88 male and 70 female patients with their age of 51.3±10.1 years. In the blood culture-positive group，there were 82 patients including 45 male and 37 female patients with their age of 48.9±9.8 years. All the patients underwent surgical treatment，and the surgical procedures included complete vegetations excision，debridement of infected valves，removal of necrotic tissue around the annulus，and concomitant heart valve replacement or intracardiac repair. Postoperatively，all the patients received routine monitoring in ICU，cardiac glycosides，diuretics，other symptomatic treatment and adequate dosages of antibiotics for 4-6 weeks. Results Four patients died postoperatively in this study including 1 patient for low cardiac output syndrome and 3 patients for multiple organ dysfunction syndrome，1 patient in the blood culture-positive group and 3 patients in the blood culture-negative group respectively. There was no statistical difference in surgical mortality between the 2 groups （χ2=0.15，P=0.70）. All the other patients were discharged successfully and followed up for 6 to 36 months with the median follow-up time of 22 months. During follow-up, 2 patients died including 1 patient for cerebral infarction 2 years after surgery and another patient for cerebral hemorrhage 3 yearsafter surgery. Conclusion Patients with blood culture-negative IE should receive adequate dosage and duration of broad-spectrum antibiotics to control the infection rapidly, and aggressive surgical therapy to decrease in-hospital mortality and improve their quality of life and prognosis.

Citation： YANG Jianguo,SONG Laichun,TAO Liang,CHEN Xufa.. Clinical Diagnosis and Surgical Therapy for Blood Culture-Negative Infective Endocarditis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 669-672. doi: 10.7507/1007-4848.20130208 Copy

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2.	Dido LL， Child IS. Infection endocarditis in congenital heart disease. Cardiol Clin， 1996， 14 （3）：383-392.
3.	符竣，陶凉，陈绪发，等. 感染性心内膜炎外科治疗时机. 中国胸心血管外科临床杂志， 2003， 10 （2）：147-148.
4.	Durack DT， Lukes AS， Bright DK. New criteria for diagnosis of infective endocarditis：utilization of speciﬁc echocardiographic ﬁndings. Am J Med ， 1994， 96 （3）：200-209.
5.	Bayer AS， Ward JI， Ginzton LE， et al. Evaluation of new clinical criteria for the diagnosis of infective endocarditis. Am J Med， 1994， 96 （3）：211-219.
6.	张尔永，石应康，程述森. 原发性感染性心内膜炎瓣膜损害的外科治疗. 中国胸心血管外科临床杂志， 1999， 6 （2）：83.
7.	Pierce D， Calkins BC， Thornton K. Infectious endocarditis：diagnosisand treatment. Am Fam Physician， 2012， 85 （10）：981-986.
8.	Houpikian P， Raoult D. Blood culture-negative endocarditis in a refer-ence center：etiologic diagnosis of 348 cases. Medicine， 2005， 84 （3）：162-173.
9.	Piper C， Horstkotte D. Endocarditis：current diagnosis and therapy. Med Klin （Munich）， 2008， 103 （4）：217-227.
10.	Brouqui P， Raoult D. Endocarditis due to rare and fastidious bacteria.Clin Microbiol Rev， 2001， 14 （1）：177-207.
11.	Christoph K， Naber， Erbel R， et al. Infective endocarditis with negative blood cultures. Int J Antimicrob Agents， 2007， 30 （Suppl 1）：S32-36.
12.	Gauduchon V， Chalabreysse L， Etienne J， et al. Molecular diagnosisof infective endocarditis by PCR amplification and direct sequencing of DNA from valve tissue. J Clin Microbiol， 2003， 41 （2）：763-766.
13.	Li JS， Sexton DJ， Mick N， et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis， 2000， 30 （4）：633-638.
14.	Jassal DS， Aminbakhsh A， Fang T， et al. Diagnostic value of harmonic transthoracic echocardiography in native valve infective endocarditis：comparison with transesophageal echocardiography. Cardiovasc Ultrasound， 2007， 5 （5）：20.
15.	Christoph KH. German guidelines for the diagnosis and management of infective endocarditis. Int J Antimicrob Agents， 2007，（29）：643–657.
16.	Chen FJ. A clinical analysis of 36 cases of infective endocarditis. Practical Clinical Med， 2007， 25 （1）：14-118.
17.	Naber CK， Paul-Ehrlich-Gesellschaft für Chemotherapie， Deutschen Gesellschaft für Kardiologie， Herz- und Kreislaufforschung， et al. S2 guideline for diagnosis and therapy of infectious endocarditis. Z Kardiol， 2004， 93 （12）：1005-1021.
18.	王波，阎德民，肖德棉，等. 感染性心内膜炎的诊断与治疗. 中国胸心血管外科临床杂志， 2010， 17 （1）：70-72.
19.	Paul-Ehrlich-Gesellschaft für Chemotherapie （PEG；Paul-Ehrlich-Society for Chemotherapy）， Deutsche Gesellschaft für Kardiologie， Herz-und Kreislaufforschung （DGK）， German Society for Cardiology， Heart， and Circulatory Research）. German guidelines for the diagnosis and management of infective endocarditis.Int J Antimicrob Agents， 2007， 29 （6）：643-657.
20.	吴泉明，胡辛兰. 26例感染性心内膜炎瓣膜赘生物病原菌分布及耐药性分析. 实验与检验医学， 2011， 29 （6）：589-592， 604.
21.	Martínez-Sellés M， Muñoz P， Estevez A， et al. Long-term outcome of infective endocarditis in non-intravenous drug users. Mayo Clin Proc， 2008， 83 （11）：1213-1217.
22.	Vikram HR， Buenconsejo J， Hasbun R， et al. Impact of valve surgery on 6-month mortality in adults with complicated， left-sided native valve endocarditis：a propensity analysis. JAMA， 2003， 290 （24）：3207-3214.
23.	Tran CT， Kjeldsen K. Endocarditis at a tertiary hospital：reduced acute mortality but poor long term prognosis. Scand J Infect Dis， 2006， 38 （8）：664-670.
24.	Cabell CH， Abrutyn E， Fowler VG Jr， et al. Use of surgery in patients with native valve infective endocarditis：results from the International Collaboration on Endocarditis Merged Database. Am Heart J， 2005， 150 （5）：1092-1098.
25.	Tornos P， Iung B， Permanyer-Miralda G， et al. Infective endocarditis in Europe：lessons from the Euro heart survey. Heart， 2005， 91 （5）：571-575.

1. 　Jursen H. Antibiotic treatment of infectious endocarditis. Tidsskr Nor Laegeforen， 200l， 121 （28）：3300-3305.
2. 　Dido LL， Child IS. Infection endocarditis in congenital heart disease. Cardiol Clin， 1996， 14 （3）：383-392.
3. 　符竣，陶凉，陈绪发，等. 感染性心内膜炎外科治疗时机. 中国胸心血管外科临床杂志， 2003， 10 （2）：147-148.
4. 　Durack DT， Lukes AS， Bright DK. New criteria for diagnosis of infective endocarditis：utilization of speciﬁc echocardiographic ﬁndings. Am J Med ， 1994， 96 （3）：200-209.
5. 　Bayer AS， Ward JI， Ginzton LE， et al. Evaluation of new clinical criteria for the diagnosis of infective endocarditis. Am J Med， 1994， 96 （3）：211-219.
6. 　张尔永，石应康，程述森. 原发性感染性心内膜炎瓣膜损害的外科治疗. 中国胸心血管外科临床杂志， 1999， 6 （2）：83.
7. 　Pierce D， Calkins BC， Thornton K. Infectious endocarditis：diagnosisand treatment. Am Fam Physician， 2012， 85 （10）：981-986.
8. 　Houpikian P， Raoult D. Blood culture-negative endocarditis in a refer-ence center：etiologic diagnosis of 348 cases. Medicine， 2005， 84 （3）：162-173.
9. 　Piper C， Horstkotte D. Endocarditis：current diagnosis and therapy. Med Klin （Munich）， 2008， 103 （4）：217-227.
10. 　Brouqui P， Raoult D. Endocarditis due to rare and fastidious bacteria.Clin Microbiol Rev， 2001， 14 （1）：177-207.
11. 　Christoph K， Naber， Erbel R， et al. Infective endocarditis with negative blood cultures. Int J Antimicrob Agents， 2007， 30 （Suppl 1）：S32-36.
12. 　Gauduchon V， Chalabreysse L， Etienne J， et al. Molecular diagnosisof infective endocarditis by PCR amplification and direct sequencing of DNA from valve tissue. J Clin Microbiol， 2003， 41 （2）：763-766.
13. 　Li JS， Sexton DJ， Mick N， et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis， 2000， 30 （4）：633-638.
14. 　Jassal DS， Aminbakhsh A， Fang T， et al. Diagnostic value of harmonic transthoracic echocardiography in native valve infective endocarditis：comparison with transesophageal echocardiography. Cardiovasc Ultrasound， 2007， 5 （5）：20.
15. 　Christoph KH. German guidelines for the diagnosis and management of infective endocarditis. Int J Antimicrob Agents， 2007，（29）：643–657.
16. 　Chen FJ. A clinical analysis of 36 cases of infective endocarditis. Practical Clinical Med， 2007， 25 （1）：14-118.
17. 　Naber CK， Paul-Ehrlich-Gesellschaft für Chemotherapie， Deutschen Gesellschaft für Kardiologie， Herz- und Kreislaufforschung， et al. S2 guideline for diagnosis and therapy of infectious endocarditis. Z Kardiol， 2004， 93 （12）：1005-1021.
18. 　王波，阎德民，肖德棉，等. 感染性心内膜炎的诊断与治疗. 中国胸心血管外科临床杂志， 2010， 17 （1）：70-72.
19. 　Paul-Ehrlich-Gesellschaft für Chemotherapie （PEG；Paul-Ehrlich-Society for Chemotherapy）， Deutsche Gesellschaft für Kardiologie， Herz-und Kreislaufforschung （DGK）， German Society for Cardiology， Heart， and Circulatory Research）. German guidelines for the diagnosis and management of infective endocarditis.Int J Antimicrob Agents， 2007， 29 （6）：643-657.
20. 　吴泉明，胡辛兰. 26例感染性心内膜炎瓣膜赘生物病原菌分布及耐药性分析. 实验与检验医学， 2011， 29 （6）：589-592， 604.
21. 　Martínez-Sellés M， Muñoz P， Estevez A， et al. Long-term outcome of infective endocarditis in non-intravenous drug users. Mayo Clin Proc， 2008， 83 （11）：1213-1217.
22. 　Vikram HR， Buenconsejo J， Hasbun R， et al. Impact of valve surgery on 6-month mortality in adults with complicated， left-sided native valve endocarditis：a propensity analysis. JAMA， 2003， 290 （24）：3207-3214.
23. 　Tran CT， Kjeldsen K. Endocarditis at a tertiary hospital：reduced acute mortality but poor long term prognosis. Scand J Infect Dis， 2006， 38 （8）：664-670.
24. 　Cabell CH， Abrutyn E， Fowler VG Jr， et al. Use of surgery in patients with native valve infective endocarditis：results from the International Collaboration on Endocarditis Merged Database. Am Heart J， 2005， 150 （5）：1092-1098.
25. 　Tornos P， Iung B， Permanyer-Miralda G， et al. Infective endocarditis in Europe：lessons from the Euro heart survey. Heart， 2005， 91 （5）：571-575.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Diagnosis and Surgical Therapy for Blood Culture-Negative Infective Endocarditis

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