Blood culture-negative infective endocarditis: a worse outcome? Results from a large multicentre retrospective Spanish cohort study.

Autor: Suardi LR; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy/Infectious Diseases Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy., de Alarcón A; Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain., García MV; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Malaga, Spain., Ciezar AP; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Regional University Hospital, Malaga, Spain., Hidalgo Tenorio C; Staff of Infectious Diseases Unit, University Hospital Virgen de las Nieves/Biomedical Research Institute (IBS), Granada, Spain., Martinez-Marcos FJ; Infectious Diseases Unit, University Hospital Juan Ramón Jiménez, Huelva, Spain., Concejo-Martínez E; Internal Medicine Unit, University Hospital Juan Ramón Jiménez, Huelva, Spain., De la Torre Lima J; Infectious Diseases Group/Internal Medicine Unit, Hospital Costa del Sol, Marbella, Spain., Vinuesa García D; Infectious Diseases Unit, University Hospital San Cecilio, Granada, Spain., Luque Márquez R; Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain., Ojeda G; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Malaga, Spain., Reguera Iglesias JM; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Regional University Hospital, Malaga, Spain., Lomas JM; Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain., Lopez-Cortes LE; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Medicine, University of Seville, Institute of Biomedicine of Seville (IBiS), Sevilla, Spain.
Jazyk: angličtina
Zdroj: Infectious diseases (London, England) [Infect Dis (Lond)] 2021 Oct; Vol. 53 (10), pp. 755-763. Date of Electronic Publication: 2021 May 26.
DOI: 10.1080/23744235.2021.1925342
Abstrakt: 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).
Databáze: MEDLINE
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