Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS-IRD UMR 6236, Faculté de Médecine, Université de la Méditerranée, 27 Blvd Jean Moulin, 13385 Marseille cedex 05, France.
Heart. 2010 May;96(10):743-7. doi: 10.1136/hrt.2009.181594. Epub 2009 Nov 11.
Context Early prosthetic valve endocarditis is a deadly disease and blood cultures remain negative in 14-30% of cases. Objectives To analyse the clinical and microbiological profile of patients with blood culture-negative (BCN) early prosthetic valve endocarditis (PVE) in order to define the most appropriate empiric treatment. Design, Setting and Participants From June 2001 to February 2009, a prospective multimodal strategy incorporating serological, molecular and histopathological assays was performed in all the samples referred to the laboratory for a suspicion of blood culture-negative endocarditis (BCNE) from France and abroad (n=718). A total of 31 patients with BCN early PVE was identified. Their microbiological profile was compared with that of 22 patients with blood culture-positive (BCP) early PVE and 628 patients with community-acquired BCNE identified during the same period. Results A pathogen was identified in 10 patients (32%) with BCN early PVE. Fungi were the most common pathogens identified, being found in 16% versus 4.5% in the case of PBC early PVE and 0.5% in community-acquired BCNE (p<0.001). The global microbiological profile of BCN early PVE differed strongly from that of PBC early PVE and community-acquired BCNE. A higher rate of microbiological diagnosis was obtained in patients who underwent surgery (9/21 (43%) vs 1/10 (10%), p=0.07) and an increased rate of recurrences was observed when a pathogen could not be identified (9/21 (43%) vs 1/10 (10%), p=0.07). Conclusions BCN early PVE exhibits specific aetiologies as fungi are the most frequent pathogens identified. Therefore, fungi should be investigated particularly by molecular methods on surgical specimens and an antifungal drug might be added to the empiric treatment.
早期人工瓣膜心内膜炎是一种致命性疾病，14%-30%的病例血培养仍为阴性。
分析血培养阴性（BCN）早期人工瓣膜心内膜炎（PVE）患者的临床和微生物学特征，以确定最合适的经验性治疗方法。
设计、地点和参与者：从 2001 年 6 月至 2009 年 2 月，采用一种包含血清学、分子和组织病理学检测的多模式前瞻性策略，对来自法国和国外所有疑似血培养阴性心内膜炎（BCNE）送检实验室的样本（n=718）进行了检测。共确定了 31 例 BCN 早期 PVE 患者。将他们的微生物特征与 22 例血培养阳性（BCP）早期 PVE 患者和同期确定的 628 例社区获得性 BCNE 患者进行了比较。
10 例（32%）BCN 早期 PVE 患者确定了病原体。真菌是最常见的病原体，在 BCN 早期 PVE 中的检出率为 16%，而在 BCP 早期 PVE 中为 4.5%，在社区获得性 BCNE 中为 0.5%（p<0.001）。BCN 早期 PVE 的整体微生物特征与 BCP 早期 PVE 和社区获得性 BCNE 有很大的不同。在接受手术的患者中，微生物学诊断率更高（9/21（43%）比 1/10（10%），p=0.07），而当无法确定病原体时，复发率更高（9/21（43%）比 1/10（10%），p=0.07）。
BCN 早期 PVE 具有特定的病因，真菌是最常见的病原体。因此，应特别通过分子方法对手术标本进行真菌检测，并在经验性治疗中加入抗真菌药物。
