McHugh Jack, Saleh Omar Abu
Division of Public Health, Infectious Diseases, Occupational Medicine, Mayo Clinic, Rochester, MN 55901, USA.
Pathogens. 2023 Aug 10;12(8):1027. doi: 10.3390/pathogens12081027.
Blood culture-negative infective endocarditis (BCNE) is a challenging condition associated with significant morbidity and mortality. This review discusses the epidemiology, microbiology, diagnosis, and treatment of BCNE considering advancements in molecular diagnostics and increased access to cardiac surgery. BCNE can be categorized into bacterial endocarditis with sterilized blood cultures due to previous antibiotic treatment, endocarditis caused by fastidious microorganisms, and true BCNE caused by intracellular organisms that cannot be cultured using traditional techniques. Non-infectious causes such as nonbacterial thrombotic endocarditis should also be considered. Diagnostic approaches involve thorough patient history; blood and serum testing, including appropriate handling of blood cultures; serological testing; and molecular techniques such as targeted and shotgun metagenomic sequencing. Where available, evaluation of explanted cardiac tissue through histopathology and molecular techniques is crucial. The therapy for BCNE depends on the likely causative agent and the presence of prosthetic material, with surgical intervention often required.
血培养阴性感染性心内膜炎（BCNE）是一种具有挑战性的疾病，与显著的发病率和死亡率相关。本综述结合分子诊断技术的进展以及心脏手术可及性的提高，讨论了BCNE的流行病学、微生物学、诊断和治疗。BCNE可分为因先前抗生素治疗导致血培养无菌生长的细菌性心内膜炎、由苛养微生物引起的心内膜炎以及由无法用传统技术培养的细胞内生物体导致的真性BCNE。还应考虑非感染性病因，如非细菌性血栓性心内膜炎。诊断方法包括详尽的患者病史；血液和血清检测，包括血培养的适当处理；血清学检测；以及分子技术，如靶向和鸟枪法宏基因组测序。在可行的情况下，通过组织病理学和分子技术对外植心脏组织进行评估至关重要。BCNE的治疗取决于可能的病原体以及是否存在人工材料，通常需要手术干预。
