Brouqui Philippe, Raoult Didier
Service des Maladies Infectieuses et Tropicales, CHU Nord AP-HM & Unité des rickettsies, Faculté de Médecine, Université de la Méditérranée, Marseilles, France.
FEMS Immunol Med Microbiol. 2006 Jun;47(1):1-13. doi: 10.1111/j.1574-695X.2006.00054.x.
Sterile blood cultures are noted in one third of patients with infectious endocarditis. Although in half of cases this is due to previous antibiotic therapy, in the other half, the aetiology of culture-negative endocarditis is intracellular bacteria such as Coxiella burnetii or fastidious growing bacteria. Although it was previously considered that the prevalence of such organisms was identical throughout the world, recent investigations on Bartonella endocarditis clearly showed that the aetiology of culture-negative endocarditis is likely to be strongly related to epidemiology of the agent in each country. During the past decade the use of molecular techniques such as PCR with subsequent sequencing to detect or to identify bacteria in valves from patients with infectious endocarditis have considerably improved the aetiological diagnosis. This is especially true in the case of culture-negative endocarditis following earlier antibiotic therapy. However, the fact that DNA remnants of past endocarditis can be detected some time after the acute episode, when the patient has been cured, suggests that the predictive value of these techniques along with the traditional histology and culture need to be evaluated closely.
三分之一的感染性心内膜炎患者血培养无菌生长。虽然半数病例是由于先前使用过抗生素治疗，但另一半病例中，血培养阴性的心内膜炎病因是细胞内细菌，如伯氏考克斯体或生长缓慢的细菌。虽然以前认为这些微生物在世界各地的患病率相同，但最近对巴尔通体心内膜炎的调查清楚地表明，血培养阴性的心内膜炎病因可能与每个国家病原体的流行病学密切相关。在过去十年中，使用聚合酶链反应（PCR）及后续测序等分子技术来检测或鉴定感染性心内膜炎患者瓣膜中的细菌，极大地改善了病因诊断。在早期抗生素治疗后血培养阴性的心内膜炎病例中尤其如此。然而，在急性发作一段时间后，当患者已治愈时仍能检测到过去心内膜炎的DNA残留，这表明这些技术以及传统组织学和培养的预测价值需要仔细评估。
