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Blood culture-negative infective endocarditis: are we looking hard enough?

Frazer Kirk1,2, Natasha Marcella Vaselli3,4,5

  • 1Gold Coast University Hospital, Southport, QLD, Australia. frazer.kirk@my.jcu.edu.au.

Infection
|October 4, 2023
PubMed

Insights

Blood culture-negative endocarditis (BCNE) presents diagnostic challenges and significant mortality. Current diagnostic criteria are insensitive, necessitating improved methods for organism identification in BCNE cases.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Diagnostics

Background:

  • Infective endocarditis is a prevalent cardiac condition associated with high mortality.
  • Blood culture-negative endocarditis (BCNE) represents a critical subgroup with substantial morbidity and mortality.

Purpose of the Study:

  • To review current literature and clinical guidelines on blood culture-negative endocarditis.
  • To synthesize findings regarding the diagnosis, causes, and complications of BCNE.

Main Methods:

  • An updated literature review was conducted.
  • Searches were performed across Web of Science, MEDLINE, EMBAS, and Scopus databases.
  • A narrative synthesis of the gathered literature was provided.

Main Results:

  • Significant heterogeneity exists in the causes and complications of BCNE due to diagnostic pathway insensitivity.
  • The modified Duke's criterion for infective endocarditis remains insensitive for detecting BCNE, despite diagnostic tool advancements.

Conclusions:

  • The natural history of BCNE and diagnostic capabilities are evolving.
  • The modified Duke's criterion requires updating to reflect current understanding and diagnostic resources.
  • Clinicians should be concerned by negative cultures in suspected BCNE, emphasizing the need for thorough organism identification.
Abstract

Keywords:
Blood culture negative endocarditisInfective endocarditisLiterature review

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