Lorenzo Roberto Suardi1, Arístides de Alarcón2, María Victoria García3, Antonio Plata Ciezar4, Carmen Hidalgo Tenorio5, Francisco Javier Martinez-Marcos6, Elena Concejo-Martínez7, Javier De la Torre Lima8, David Vinuesa García9, Rafael Luque Márquez2, Guillermo Ojeda3, José M Reguera Iglesias4, José M Lomas2, Luis E Lopez-Cortes10. 1. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy/Infectious Diseases Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy. 2. 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. 3. Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Malaga, Spain. 4. Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Regional University Hospital, Malaga, Spain. 5. Staff of Infectious Diseases Unit, University Hospital Virgen de las Nieves/Biomedical Research Institute (IBS), Granada, Spain. 6. Infectious Diseases Unit, University Hospital Juan Ramón Jiménez, Huelva, Spain. 7. Internal Medicine Unit, University Hospital Juan Ramón Jiménez, Huelva, Spain. 8. Infectious Diseases Group/Internal Medicine Unit, Hospital Costa del Sol, Marbella, Spain. 9. Infectious Diseases Unit, University Hospital San Cecilio, Granada, Spain. 10. 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.
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).
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).
Authors: Alfonso Jan Kemp Pecoraro; Colette Pienaar; Philippus George Herbst; Simon Poerstamper; Lloyd Joubert; Jantjie Taljaard; Hans Prozesky; Jacques Janson; Mae Newton-Foot; Anton Frans Doubell Journal: BMJ Open Date: 2021-12-06 Impact factor: 2.692