Godfrey Rebecca, Curtis Sally, Schilling William Hk, James P Rachael
Sussex Cardiac Centre, Brighton, UK.
Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Clin Med (Lond). 2020 Jul;20(4):412-416. doi: 10.7861/clinmed.2019-0342.
Blood culture negative endocarditis (BCNE) accounts for up to 20% of infective endocarditis. While the most common cause of BCNE remains the initiation of antibiotics prior to culture, intracellular organisms such as and spp account for a significant proportion of cases. Identifying the infecting organism remains important to ensure optimal antimicrobial treatment. However, these organisms can be difficult to diagnose. We outline a systematic approach to BCNE. Over half of patients with infective endocarditis now undergo early surgery and 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR) of excised tissue can be vitally important to secure a diagnosis. Molecular testing is likely to become a key tool in improving outcomes from BCNE and contribute to an improved understanding of the aetiology. We advocate modifying the Duke criteria to incorporate organisms identified on molecular testing, including 16S rRNA PCR, in particular from explanted tissue.
血培养阴性的心内膜炎（BCNE）占感染性心内膜炎的比例高达20%。虽然BCNE最常见的原因仍是在培养前使用了抗生素，但细胞内生物体如[具体名称1]和[具体名称2]属在病例中占相当大的比例。确定感染病原体对于确保最佳抗菌治疗仍然很重要。然而，这些病原体可能难以诊断。我们概述了一种针对BCNE的系统方法。现在超过一半的感染性心内膜炎患者接受早期手术，对切除组织进行16S核糖体核糖核酸（rRNA）聚合酶链反应（PCR）对于确诊至关重要。分子检测可能会成为改善BCNE治疗结果的关键工具，并有助于增进对病因的了解。我们主张修改杜克标准，将分子检测（包括16S rRNA PCR）所鉴定的病原体纳入其中，特别是来自切除组织的病原体。
