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Duration of Pre-Operative Antibiotic Treatment and Culture Results in Patients With Infective Endocarditis

Valentin Gisler1, Sarah Dürr2, Irina Irincheeva3

  • 1Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Infectious Diseases and Hospital Hygiene, Cantonal Hospital Aarau, Aarau, Switzerland.

Journal of the American College of Cardiology
|July 4, 2020
PubMed
Abstract

Insights

Pre-operative antibiotic treatment (preop-AT) for infective endocarditis (IE) impacts valve culture results. While initial treatment reduces positive cultures, prolonged preop-AT beyond 21 days shows no additional benefit for bacterial growth in heart valve cultures.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Microbiology

Background:

  • Infective endocarditis (IE) bacterial growth in heart valve cultures is influenced by pre-operative antibiotic treatment (preop-AT).
  • Understanding the temporal relationship between preop-AT and valve culture outcomes is crucial for optimizing IE management.

Purpose of the Study:

  • To evaluate the time-dependent effect of preop-AT on valve culture results (positive vs. negative) in patients with IE.
  • To determine the optimal duration of preop-AT for achieving negative valve cultures.

Main Methods:

  • Retrospective analysis of 352 IE episodes in adult patients (2005-2016).
  • Primary endpoint: positive valve culture (PVC) results.
  • Logistic additive model adjusted for bacterial species, McCabe-Jackson classification, and foreign valve material.

Main Results:

  • Among 231 included IE cases, 25% had PVC.
  • Enterococcus spp. and Staphylococcus spp. were significantly associated with PVC (ORs 6.35 and 3.93, respectively).
  • Preop-AT showed risk reduction for PVC up to day 13, with minor additional effects per 2-day interval; no influence beyond 21 days.

Conclusions:

  • Staphylococcus aureus and Enterococcus spp. are linked to valve culture growth in IE patients undergoing surgery.
  • The impact of preop-AT on valve culture results diminishes significantly after 7 days.
  • Antibiotic treatment exceeding 21 days does not influence heart valve culture outcomes in IE.
Keywords:
cardiac valve culturesinfective endocarditispre-operative antibiotic treatment

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