Systematic serological testing in infective endocarditis: Limited clinical impact despite high usage-a 14-year cohort...

Area of Science:

• Infectious Diseases
• Cardiology
• Clinical Microbiology

Background:

• Infective endocarditis (IE) diagnosis can be challenging, particularly in blood-culture negative IE (BCNIE) cases.
• Serological testing is often employed, but its clinical utility in routine IE management requires evaluation.

Purpose of the Study:

• To assess the clinical utility of systematic serological testing in infective endocarditis (IE).
• To determine the prevalence of blood-culture negative IE (BCNIE) and its clinical presentation.
• To compare outcomes between BCNIE and blood-culture positive IE (BCPIE).

Main Methods:

• Retrospective analysis of 296 consecutive IE episodes from 2008-2021.
• Comparison of clinical characteristics, serological testing patterns, and outcomes between BCNIE and BCPIE.
• Multivariate analysis to identify factors associated with clinical outcomes.

Main Results:

• BCNIE constituted 22.3% of IE cases, with higher prior antibiotic use.
• Serological testing was common, with positive results for Coxiella burnetii, Bartonella henselae, Mycoplasma pneumoniae, and Brucella spp.
• Despite positive serological results, only one patient received targeted therapy, and no serological marker improved outcomes.

Conclusions:

• Systematic serological testing in IE offers limited diagnostic and therapeutic value.
• A selective, risk-factor-based approach for BCNIE is more appropriate and cost-effective.
• Further research may refine targeted serological testing strategies for specific IE etiologies.