Pesanti E L, Smith I M
Am J Med. 1979 Jan;66(1):43-50. doi: 10.1016/0002-9343(79)90480-7.
The clinical records of 52 patients who were diagnosed clinically as having had infective endocarditis despite negative blood cultures have been reviewed. They differed at presentation from patients with positive blood cultures in more frequent receipt of antibiotics prior to culture and more frequent signs of major systemic emboli and congestive heart failure. Response of culture-negative patients with fever to empiric antibiotic therapy was correlated with survival, in that 92 per cent of the patients who became afebrile within the first week of therapy liver, whereas only 50 per cent of those who did not become afebrile lived. Deaths resulted primarily from major systemic emboli and from uncontrollable congestive heart failure due to valvular insufficiency. In 25 cases, valvular tissue was examined histologically. In 15 cases, vegetations were seen and organisms identified; in six cases, only vegetations were seen; and in four cases (16 per cent), the clinical diagnosis of infective endocarditis was not substantiated in the pathologic report.
对52例临床诊断为感染性心内膜炎但血培养阴性的患者的临床记录进行了回顾。他们在就诊时与血培养阳性的患者不同，在培养前更频繁地接受抗生素治疗，更频繁地出现主要系统性栓塞和充血性心力衰竭的体征。培养阴性发热患者对经验性抗生素治疗的反应与生存率相关，即治疗第一周内退热的患者中有92%存活，而未退热的患者中只有50%存活。死亡主要是由于主要系统性栓塞和瓣膜功能不全导致的无法控制的充血性心力衰竭。在25例病例中，对瓣膜组织进行了组织学检查。在15例病例中，发现了赘生物并鉴定出了病原体；在6例病例中，仅发现了赘生物；在4例病例（16%）中，病理报告未证实感染性心内膜炎的临床诊断。
