Filiz Mine, Erdem Hakan, Ankarali Handan, Puca Edmond, Ruch Yvon, Santos Lurdes, Fasciana Teresa, Giammanco Anna M, Ghanem-Zoubi Nesrin, Argemi Xavier, Hansmann Yves, Guner Rahmet, Tonziello Gilda, Mazzucotelli Jean-Philippe, Como Najada, Kose Sukran, Batirel Ayse, Inan Asuman, Tulek Necla, Pekok Abdullah Umut, Khan Ejaz Ahmed, Iyisoy Atilla, Meric-Koc Meliha, Kaya-Kalem Ayse, Martins Pedro Palma, Hasanoglu Imran, Silva-Pinto André, Oztoprak Nefise, Duro Raquel, Almajid Fahad, Dogan Mustafa, Dauby Nicolas, Gunst Jesper Damsgaard, Tekin Recep, Konopnicki Deborah, Petrosillo Nicola, Bozkurt Ilkay, Al Ramahi Jamal Wadi, Popescu Corneliu, Balkan Ilker Inanc, Ozer-Balin Safak, Zupanc Tatjana Lejko, Cascio Antonio, Dumitru Irina Magdalena, Erdem Aysegul, Ersoz Gulden, Tasbakan Meltem, Ajamieh Oday Abu, Sirmatel Fatma, Florescu Simin, Gulsun Serda, Ozkaya Hacer Deniz, Sari Sema, Tosun Selma, Avci Meltem, Cag Yasemin, Celebi Guven, Sagmak-Tartar Ayse, Karakus Sumeyra, Sener Alper, Dedej Arjeta, Oncu Serkan, Del Vecchio Rosa Fontana, Ozturk-Engin Derya, Agalar Canan
Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Gulhane School of Medicine, Ankara, Turkey.
Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey.
New Microbes New Infect. 2024 Jul 14;60-61:101453. doi: 10.1016/j.nmni.2024.101453. eCollection 2024 Aug-Oct.
Blood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE.
The study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses.
Blood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963-0.987, p < 0.001). Additionally, factors such as rheumatic heart disease (OR 2.036, 95 % CI 0.970-4.276, p = 0.049), aortic stenosis (OR 3.066, 95 % CI 1.564-6.010, p = 0.001), mitral regurgitation (OR 1.693, 95 % CI 1.012-2.833, p = 0.045), and prosthetic valves (OR 2.539, 95 % CI 1.599-4.031, p < 0.001) are associated with higher likelihoods of negative blood cultures. Our model can predict whether a patient falls into the culture-negative or culture-positive groups with a threshold of 0.104 (AUC±SE = 0.707 ± 0.027). The final model demonstrates a sensitivity of 70.3 % and a specificity of 57.0 %.
Caution should be exercised when diagnosing endocarditis in patients with concurrent cardiac disorders, particularly in younger cases.
血培养阴性的心内膜炎（BCNE）是一项诊断挑战，因此我们的目标是确定BCNE的高危人群。
该研究纳入了确诊为心内膜炎的成年患者。数据通过传染病国际研究倡议（ID-IRI）收集。这项分析有史以来报告的最大病例系列之一的研究在13个国家的41个中心进行。我们使用单变量和逻辑回归分析对数据库进行分析，以确定BCNE的预测因素。
867例患者中有101例（11.65%）血培养结果为阴性。我们发现，随着患者年龄增长，血培养阴性的可能性显著降低（比值比0.975，95%置信区间0.963-0.987，p<0.001）。此外，风湿性心脏病（比值比2.036，95%置信区间0.970-4.276，p=0.049）、主动脉瓣狭窄（比值比3.066，95%置信区间1.564-6.010，p=0.001）、二尖瓣反流（比值比1.693，95%置信区间1.012-2.833，p=0.045）和人工瓣膜（比值比2.539，95%置信区间1.599-4.031，p<0.001）等因素与血培养阴性的较高可能性相关。我们的模型可以以0.104的阈值预测患者属于血培养阴性组还是血培养阳性组（曲线下面积±标准误=0.707±0.027）。最终模型的敏感性为70.3%，特异性为57.0%。
在诊断合并心脏疾病的患者的心内膜炎时应谨慎，尤其是年轻患者。
