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Investigation of blood culture-negative early prosthetic valve endocarditis reveals high prevalence of fungi
  1. Franck Thuny1,2,
  2. Pierre-Edouard Fournier1,3,
  3. Jean-Paul Casalta3,
  4. Frédérique Gouriet1,3,
  5. Hubert Lepidi1,3,
  6. Alberto Riberi4,
  7. Frédéric Collart4,
  8. Gilbert Habib2,
  9. Didier Raoult
  1. 1Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Centre Nationale de la Recherche Scientifique (CNRS), Faculté de Médecine, Université de la Méditerranée, Marseille, France
  2. 2Service de Cardiologie, Hôpital de la Timone, Marseille, France
  3. 3Pôle de Maladies Infectieuses, Hôpital de la Timone, Marseille, France
  4. 4Service de Chirurgie Cardiaque, Hôpital de la Timone, Marseille, France
  1. Correspondence to Professeur Didier Raoult, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS-IRD UMR 6236, Faculté de Médecine, Université de la Méditerranée, 27 Blvd Jean Moulin, 13385 Marseille cedex 05, France; didier.raoult{at}gmail.com

Abstract

Context Early prosthetic valve endocarditis is a deadly disease and blood cultures remain negative in 14–30% of cases.

Objectives To analyse the clinical and microbiological profile of patients with blood culture-negative (BCN) early prosthetic valve endocarditis (PVE) in order to define the most appropriate empiric treatment.

Design, Setting and Participants From June 2001 to February 2009, a prospective multimodal strategy incorporating serological, molecular and histopathological assays was performed in all the samples referred to the laboratory for a suspicion of blood culture-negative endocarditis (BCNE) from France and abroad (n=718). A total of 31 patients with BCN early PVE was identified. Their microbiological profile was compared with that of 22 patients with blood culture-positive (BCP) early PVE and 628 patients with community-acquired BCNE identified during the same period.

Results A pathogen was identified in 10 patients (32%) with BCN early PVE. Fungi were the most common pathogens identified, being found in 16% versus 4.5% in the case of PBC early PVE and 0.5% in community-acquired BCNE (p<0.001). The global microbiological profile of BCN early PVE differed strongly from that of PBC early PVE and community-acquired BCNE. A higher rate of microbiological diagnosis was obtained in patients who underwent surgery (9/21 (43%) vs 1/10 (10%), p=0.07) and an increased rate of recurrences was observed when a pathogen could not be identified (9/21 (43%) vs 1/10 (10%), p=0.07).

Conclusions BCN early PVE exhibits specific aetiologies as fungi are the most frequent pathogens identified. Therefore, fungi should be investigated particularly by molecular methods on surgical specimens and an antifungal drug might be added to the empiric treatment.

  • Diagnosis
  • endocarditis
  • prosthesis
  • surgery
  • valves

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Footnotes

  • Linked articles 188987.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the local ethics committee under reference 07-015. The study was also approved by the Commission Nationale Informatique et Libertés under reference 1223186.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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