Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Ann Thorac Surg. 2013 Apr;95(4):1467-74. doi: 10.1016/j.athoracsur.2012.10.044. Epub 2013 Mar 5.
Diagnosis and management of blood culture-negative endocarditis constitute a formidable clinical challenge and a systemic approach is necessary for a successful outcome. Blood cultures are negative in endocarditis due mainly to preceding antibiotic administration or to fastidious slow-growing organisms. Less so, non-infective endocarditis is a paraneoplastic manifestation or may occur in association with autoimmune diseases. When the clinical diagnosis is contemplated and cultures and serologies are negative, histologic and molecular examination of the removed valve tissue may confirm the diagnosis. Treatment with antibiotics is often warranted and valve replacement remains appropriate for patients with heart failure or irreversible structural damage.
血培养阴性心内膜炎的诊断和治疗是一项艰巨的临床挑战，需要采取系统性方法才能取得良好的结果。血培养阴性主要是由于先前使用抗生素或由于苛养、生长缓慢的病原体所致。此外，非感染性心内膜炎是一种副肿瘤表现，或者可能与自身免疫性疾病相关。当考虑临床诊断，且培养和血清学检查均为阴性时，对切除的瓣膜组织进行组织学和分子检查有助于确诊。常需要进行抗生素治疗，对于心力衰竭或出现不可逆结构性损害的患者，瓣膜置换仍然适用。
