14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
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Final Abstract Number: 25.020
Session: Clinical Bacterial Infections
Date: Wednesday, March 10, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Blood culture negative infective endocarditis (IE). Clinical features, long- term outcome and
comparison with positive blood culture IE
F. Nacinovich 1 , E. Perez Carrega 1 , M. Trivi 1 , J. Thierer 2 , D. Navia 1 , F. Piccinini 1 , M. Marin 3 , A.
Sucari 3 , P. Fernandez Oses 3 , D. Stamboulian 4
1 ICBA, Buenos Aires, Argentina, 2 Blanco Encalada 1543, Ciudad Autonoma de Buenos Aires,
Argentina, 3 FUNCEI, Ciudad Autonoma de Buenos Aires, Argentina, 4 FUNCEI; Clinical Director,
Ciudad Autonoma de Buenos Aires, Argentina
Background: Blood-culture negative infective endocarditis (BCNIE) is a challenge for clinicians,
due in part to the difficult diagnosis and the appropriate choice of antibiotic treatment.
Methods: To evaluate clinical findings and long-term outcome of patients (pts) with BCNIE vs pts
with positive blood cultures IE (BCPIE) we analize a prospective observational registry of
consecutive definitive episodes (ep) of IE according to modified Duke criteria admitted at the
institution. Patients follow up was made by patient visits and/or phone calls. The outcome
(relapse and reinfection) was evaluated by Kaplan Mayer method.
Results: From August 1998 through December 2006, 177 ep. of IE in 169 patients were
included. One hundred and thirty four (75,7%) were definitive IE; 32 (23,8%) were BCNIE.
Median age 67 y/o (range=16-87); male 25 (78,2%). Previous antibiotic therapy was used in
14/32 ep (43,75%). NVIE 12/32, PVIE 11/32 (5 early) and 9 intracardiac devices. Aortic valve 15,
Mitral valve 6, Tricuspid valve 1 and both aortic and mitral valve 1. Clinical picture: fever 25
(78%), sepsis 5 (15,6%), new regurgitation heart murmur 9 (28%). Complications were found in
18/32 patients (56,2%): heart failure 11 (61%), embolic events 6 (75%; 4 were in CNS). Surgery:
24/32 (75%); 13/24 had a positive valve culture or valve PCR. In-hospital mortality: 4/32 (12.5%;
2/24 with surgery). Long-term follow up lasted 1034 days (range 67-3492) and there were 4
relapses (16,5%). The overall mortality was 46,4% (13/28); 8/13 died patients had previous
surgery (61,5%). Compared with pts with BCPIE, it was noted that pts with BCNIE more
frequently have intracardiac devices (prosthetic valves and pacemakers), surgical treatment and
a double rate of mortality in the long-term follow up group. The other variables did not show a
statistically significant difference.
Conclusion: BCNIE represents a challenge in the clinical practice. It is noteworthy that half of
cases had previous antimicrobial therapy; this observation must conscious us about antibiotic
use, especially in those patients with intracardiac devices. The mortality and complications makes
necessary a lasting and rigorous follow up of pts with BCNIE.