Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry
William Kong, Antonio Salsano, Daniele Roberto Giacobbe, Bogdan A. Popescu, Cécile Laroche, Xavier Duval, Robert Schueler, Antonella Moreo, Paolo Colonna, Cornelia Piper, Francisco Calvo, Luigi P. Badano, Ilija Srdanović, David Boutoille, Olivier Huttin, Elisabeth Stöhr, Ana Teresa Timóteo, J. Vaskelyte, Anita Sadeghpour, Pilar Tornos, Leïla Abid, Kian Keong Poh, Gilbert Habib, Patrizio Lancellotti, the EURO-ENDO Investigators, Gilbert Habib, Patrizio Lancellotti, Bernard Cosyns, Erwan Donal, Paola Anna Erba, Gilbert Habib, Bernard Iung, Aldo P. Maggioni, Bogdan A Popescu, Bernard Prendergast, Pilar Tornos, Nora Nabila Ali Tatar-Chentir, Mouaz H. Al‐Mallah, Meriam Åström Aneq, George Athanassopoulos, Luigi P. Badano, S. Benyoussef, Erick Calderón-Aranda, Nuno Cardim, Kwan‐Leung Chan, Bernard Cosyns, Ines Cruz, Thor Edvardsen, Georg Goliasch, Gilbert Habib, Andreas Hagendorff, Krasimira Hristová, Bernard Iung, Otto Kamp, Duk‐Hyun Kang, William Kong, С.Т. Мацкеплишвили, Marwa Meshaal, M Mirocevic, Aleksandar Nešković, Michal Pazderník, Edyta Płońska‐Gościniak, Bogdan A Popescu, Bernard Prendergast, Maha Raissouni, Ricardo Ronderos, Leyla Elif Sade, Anita Sadeghpour, Antonia Sambola, Shantanu P. Sengupta, Jadranka Šeparović Hanževački, Masaaki Takeuchi, Edwin S. Tucay, Ana Clara Tude Rodrigues, Albert Varga, Jolanta Justina Vaškelytė, Kentaro Yamagata, Kyriakos Yiangou, Hosam Zaky, Ricardo Ronderos, Gustavo Avegliano, P. Fernandez Oses, Eduardo Filipini, Isabel Granada, Ana Iribarren, M Mahia, Francisco Nacinovich, S Ressi, R Obregon, M Bangher, J Dho, Luis R Cartasegna, M. Plastino, V Novas, C Shigel, Graciela Reyes, M De Santos, Natalio Gastaldello, M Granillo Fernandez, M Potito
Abstract
AIM: Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). METHODS AND RESULTS: This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04-1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41-0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly different in CNIE vs. CPIE patients who underwent surgery. CONCLUSION: The present analysis of the EURO-ENDO registry confirms a higher long-term mortality in patients with CNIE compared with patients with CPIE. This difference was present in patients receiving medical therapy alone and not in those who underwent surgery, with surgery being associated with reduced mortality. Additional efforts are required both to improve the aetiological diagnosis of IE and identify CNIE cases early before progressive disease potentially contraindicates surgery.