Retrospective study of the diagnosis and treatment of culture-negative aortic infective endocarditis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DONG Xiaochao , YANG Jinbao , DUAN Weixun , LIU Dawei , LIU Yang ,  YU Shiqiang

Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, P.R.China;

Corresponding author：

YU Shiqiang, Email: yusq@fmmu.edu.cn

Keywords：

Infective endocarditis; culture-negative; aortic valve; treatment

DOI：

10.7507/1007-4848.201905035

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Objective To discuss the diagnosis and treatment of culture-negative aortic infective endocarditis.Methods The clinical data of 73 patients with infective endocarditis of the aortic valve whose results of bacteria culture were negative from January 2013 to January 2018 were retrospectively analyzed, including 59 males and 14 females aged 14-71 (39.2±14.8) years.Results Sixty seven (91.8%) patients received aortic valve replacement, 2 (2.7%) patients received the second operation in hospital, and 12 (16.4%) patients had concomitant mitral valvuloplasty. In-hospital death occurred in 8 (11.0%) patients. Postoperatively, 11 (20.7%) patients had a low cardiac output and 4 (11.0%) patients had heart block, and 1 patient required implantation of a permanent pacemaker. The 1- and 5- year survival rates were 92.3%±2.3% and 84.5%±4.5%, respectively.Conclusion There are difficulties in the diagnosis and treatment of culture-negative infective endocarditis. Most of the affected patients are in a healed status, which could be a cause of negative culture results. In-hospital mortality in the patients is associated with a history of previous cardiac surgery, whereas the long-term survival rate is good for the patients after surgery.

Citation： DONG Xiaochao, YANG Jinbao, DUAN Weixun, LIU Dawei, LIU Yang, YU Shiqiang. Retrospective study of the diagnosis and treatment of culture-negative aortic infective endocarditis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(7): 749-753. doi: 10.7507/1007-4848.201905035 Copy

1.	Tanaka M, Kohno T, Obara H, et al. Progressive mycotic celiac artery aneurysm associated with coagulase-negative staphylococcal prosthetic valve endocarditis. Circ J, 2017, 82(7): 1965-1967.
2.	Gatti G, Perrotti A, Obadia J, et al. Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis. J Am Heart Assoc, 2017, 6(7): e004806.
3.	Zegri-Reiriz I, de Alarcón A, Muñoz P, et al. Infective endocarditis in patients with bicuspid aortic valve or mitral valve prolapse. J Am Coll Cardiol, 2018, 71(24): 2731-2740.
4.	Gomes A, Jainandunsing JS, Assen SV, et al. A standardized approach to treat complex aortic valve endocarditis: a case series. J Cardiothorac Surg, 2018, 13(1): 32.
5.	Kanamori H, Kakuta R, Yano H, et al. A case of culture-negative endocarditis due to Streptococcus tigurinus. J Infect Chemother, 2015, 21(2): 138-140.
6.	Okaro U, Addisu A, Casanas B, et al. Bartonella species, an emerging cause of blood-culture-negative endocarditis. Clin Microbiol Rev, 2017, 30(3): 709.
7.	Menu E, Gouriet F, Casalta JP, et al. Evaluation of empirical treatment for blood culture-negative endocarditis. J Antimicrob Chemother, 2017, 72(1): 290-298.
8.	Sumatani I, Kagiyama N, Saito C, et al. Infective endocarditis with negative blood culture and negative echocardiographic findings. J Echocardiogr, 2015, 13(2): 1-3.
9.	Renzulli R, Carozza A, Marra C, et al. Are blood and valve cultures predictive for long-term outcome following surgery for infective endocarditis? Eur J Cardiothorac Surg, 2000, 17(3): 228-233.
10.	Hingwe A, Samuel L. Culture-negative endocarditis: diagnosis by polymerase chain reaction. Infect Dis Clin Pract, 2010, 18(3): 221-223.
11.	Casalta JP, Habib G, La Scola B, et al. Molecular diagnosis of Granulicatella elegans on the cardiac valve of a patient with culture-negative endocarditis. J Clin Microbiol, 2002, 40(5): 1845-1847.
12.	Hasegawa MI, Kyo S, Asano H, et al. Surgery for active, culture negative endocarditis. Asian Cardiovasc Thorac Ann, 2004, 12(4): 316-319.
13.	杨世杰, 韩娓娜, 霍志荣. 感染性心内膜炎患者血培养阴性临床分析. 中华医院感染学杂志, 2015, 3: 600-602.
14.	徐晓斌, 楼丹萍, 张建军. 能谱 CT 动脉成像在感染性心内膜炎致脓毒性肺栓塞中的诊断评价. 中华医院感染学杂志, 2014, 15: 3893-3895.
15.	Toker ME, Eren E, Guler M, et al. Second and third cardiac valve reoperations: factors influencing death and long-term survival. Tex Heart Inst J, 2009, 36(6): 557.
16.	Pang PY, Sin YK, Lim CH, et al. Surgical management of infective endocarditis: an analysis of early and late outcomes. Eur J Cardiothorac Surg, 2015, 47(5): 826.

1. Tanaka M, Kohno T, Obara H, et al. Progressive mycotic celiac artery aneurysm associated with coagulase-negative staphylococcal prosthetic valve endocarditis. Circ J, 2017, 82(7): 1965-1967.
2. Gatti G, Perrotti A, Obadia J, et al. Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis. J Am Heart Assoc, 2017, 6(7): e004806.
3. Zegri-Reiriz I, de Alarcón A, Muñoz P, et al. Infective endocarditis in patients with bicuspid aortic valve or mitral valve prolapse. J Am Coll Cardiol, 2018, 71(24): 2731-2740.
4. Gomes A, Jainandunsing JS, Assen SV, et al. A standardized approach to treat complex aortic valve endocarditis: a case series. J Cardiothorac Surg, 2018, 13(1): 32.
5. Kanamori H, Kakuta R, Yano H, et al. A case of culture-negative endocarditis due to Streptococcus tigurinus. J Infect Chemother, 2015, 21(2): 138-140.
6. Okaro U, Addisu A, Casanas B, et al. Bartonella species, an emerging cause of blood-culture-negative endocarditis. Clin Microbiol Rev, 2017, 30(3): 709.
7. Menu E, Gouriet F, Casalta JP, et al. Evaluation of empirical treatment for blood culture-negative endocarditis. J Antimicrob Chemother, 2017, 72(1): 290-298.
8. Sumatani I, Kagiyama N, Saito C, et al. Infective endocarditis with negative blood culture and negative echocardiographic findings. J Echocardiogr, 2015, 13(2): 1-3.
9. Renzulli R, Carozza A, Marra C, et al. Are blood and valve cultures predictive for long-term outcome following surgery for infective endocarditis? Eur J Cardiothorac Surg, 2000, 17(3): 228-233.
10. Hingwe A, Samuel L. Culture-negative endocarditis: diagnosis by polymerase chain reaction. Infect Dis Clin Pract, 2010, 18(3): 221-223.
11. Casalta JP, Habib G, La Scola B, et al. Molecular diagnosis of Granulicatella elegans on the cardiac valve of a patient with culture-negative endocarditis. J Clin Microbiol, 2002, 40(5): 1845-1847.
12. Hasegawa MI, Kyo S, Asano H, et al. Surgery for active, culture negative endocarditis. Asian Cardiovasc Thorac Ann, 2004, 12(4): 316-319.
13. 杨世杰, 韩娓娜, 霍志荣. 感染性心内膜炎患者血培养阴性临床分析. 中华医院感染学杂志, 2015, 3: 600-602.
14. 徐晓斌, 楼丹萍, 张建军. 能谱 CT 动脉成像在感染性心内膜炎致脓毒性肺栓塞中的诊断评价. 中华医院感染学杂志, 2014, 15: 3893-3895.
15. Toker ME, Eren E, Guler M, et al. Second and third cardiac valve reoperations: factors influencing death and long-term survival. Tex Heart Inst J, 2009, 36(6): 557.
16. Pang PY, Sin YK, Lim CH, et al. Surgical management of infective endocarditis: an analysis of early and late outcomes. Eur J Cardiothorac Surg, 2015, 47(5): 826.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Retrospective study of the diagnosis and treatment of culture-negative aortic infective endocarditis

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