Lamichhane Bikal, Lamichhane Saral, Paudel Kusum, Pokhrel Nishan B, Dhital Sandhya, Acharya Surya Kiran
Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA.
Internal Medicine, Gandaki Medical College, Pokhara.
Ann Med Surg (Lond). 2023 Dec 18;86(2):1161-1165. doi: 10.1097/MS9.0000000000001638. eCollection 2024 Feb.
Blood culture-negative infective endocarditis is the condition in which a causative organism cannot be identified after inoculation of at least three samples using standard blood-culture systems for 7 days. It has a low reported incidence of about 2.5-31%. Causes may be infectious or non-infectious; use of prior antibiotic therapy is usually the leading factor.
The authors present a case of true culture-negative endocarditis involving the mitral valve, with multiple foci of spread including brain, spleen, liver, and Intervertebral disc, which remained persistent despite treatment with intravenous broad-spectrum antibiotics on an inpatient and outpatient basis but eventually improved after upgrading alternative broad-spectrum antibiotic for an extended duration. The patient had complications in the form of a flail mitral valve with persistent mitral regurgitation, requiring mitra-clip placement.
Positive blood culture is one of the major diagnostic criteria to establish infective endocarditis. Patients may have persistent negative cultures due to previous antibiotic use, the presence of fastidious organisms, or the use of inappropriate techniques or media. Involvement of a multidisciplinary team, use of multimodal investigations, and appropriate antibiotic stewardship are crucial. Extended duration of treatment and upgrading antibiotics can be helpful next steps in highly suspicious cases. With multifocal spread as in our case, it further becomes challenging to control and treat the infection as it is frequently connected with higher morbidity and mortality.
Blood culture-negative endocarditis is an entity that can present with early complications. It is diagnostically and therapeutically challenging to treat such patients. Multimodal approaches for early diagnosis and appropriate treatment are crucial owing to its high morbidity and mortality.
血培养阴性感染性心内膜炎是指使用标准血培养系统接种至少三个样本并培养7天后仍无法鉴定出致病微生物的情况。其报告发病率较低，约为2.5%-31%。病因可能是感染性或非感染性的；先前使用抗生素治疗通常是主要因素。
作者报告一例累及二尖瓣的真正血培养阴性心内膜炎病例，有多个播散灶，包括脑、脾、肝和椎间盘，尽管在住院和门诊期间接受了静脉广谱抗生素治疗，但病情仍持续存在，但在延长使用替代广谱抗生素后最终有所改善。患者出现连枷样二尖瓣伴持续性二尖瓣反流的并发症，需要放置二尖瓣夹。
血培养阳性是诊断感染性心内膜炎的主要标准之一。由于先前使用抗生素、存在苛养菌或使用不当技术或培养基，患者的培养结果可能持续为阴性。多学科团队的参与、多模式检查的使用以及适当的抗生素管理至关重要。在高度可疑的病例中，延长治疗时间和升级抗生素可能是下一步有用的措施。如我们的病例所示，由于多灶性播散，感染的控制和治疗更具挑战性，因为它常常与更高的发病率和死亡率相关。
血培养阴性心内膜炎是一种可出现早期并发症的疾病。治疗此类患者在诊断和治疗上具有挑战性。由于其高发病率和死亡率，早期诊断和适当治疗的多模式方法至关重要。
