Is It Useful to Repeat Blood Cultures in Endocarditis Patients? A Critical Appraisal
Abstract
:1. Introduction
2. The Definitions of Persistent Bacteremia
3. Definitions and Consequences of Persistent and Uncontrolled Infection
4. What Is the Role of Repeating Blood Cultures to Identify Those at Risk for Persistent Infection?
5. The Incidence, Risks and Associations of Persistent Infection
6. Why Do We Need Negative Blood Cultures as the Starting Point of Antibiotic Therapy Duration?
7. What Is the Time Needed to Clear Bacteria from Affected Valves in Endocarditis?
8. Conclusions
Supplementary Materials
Funding
Conflicts of Interest
References
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AHA Guideline 2015 | ESC Guideline 2015 | |
---|---|---|
Persistent infection | Persistent bacteremia or fever lasting >5–7 days despite appropriate antibiotic therapy. | Persisting fever and positive blood culture (>7–10 days) despite an appropriate antibiotic regimen. |
Action required | Excluding other sites of infection and fever. | Replacement of i.v. lines, repeat laboratory measurements, blood cultures, echocardiography, and the search for an intracardiac or extracardiac focus of infection. |
Surgery is indicated when persistent bacteremia or fever lasting >5–7 days despite appropriate antibiotic therapy and provided that other sites
of infection and fever have been excluded. | Surgery has been indicated when fever and positive blood cultures persist for several days (7–10 days) despite an appropriate antibiotic regimen and when extracardiac abscesses (splenic, vertebral, cerebral, or renal) and other causes of fever have been excluded. However, the best timing for surgery in this difficult situation is unclear. Recently it has been demonstrated that persistent blood cultures 48–72 h after initiation of antibiotics are an independent risk factor for hospital mortality (Lopez 2012 [10]). These results suggest that surgery should be considered when blood cultures remain positive after 3 days of antibiotic therapy, after the exclusion of other causes of persistent positive blood cultures (adapted antibiotic regimen). | |
Uncontrolled infection |
AHA guidelines do not use the term uncontrolled infection and present individual reasons for surgery.
Persisting fever and positive blood cultures (>5–7 days), provided that other sites of infection and fever have been excluded, is one of them. | Locally uncontrolled infection (increasing vegetation size, abscess formation, false aneurysms, and the creation of fistulae) OR persisting fever and positive blood culture (>7–10 days), OR infection due to fungi or multiresistant organisms or in the rare infections caused by Gram-negative bacteria. |
Action required | Surgery is recommended for uncontrolled infection. | Surgery is recommended as soon as possible. Rarely when there are no other reasons for surgery and fever is easily controlled with antibiotics, small abscesses or false aneurysms can be treated conservatively under close clinical and echocardiographic follow-up. |
Study | Number of Patients and % Native Valves | Number of Patients with Positive Valve Culture (% of Total) | Influence of Duration of Antibiotic Treatment on % Positive Valve Culture |
---|---|---|---|
Morris 2003 [32] | 480 (62% native) | 130 (30%) | In terms of standard duration of antibiotic treatment completed: ≤50%: 116/214 (54.2%) >50%: 14/145 (9.7%) |
Upton 2005 [33] | 131 (66% native), with Streptococcal endocarditis | 25 (19%) | ≤14 days: 24/69 (34.8%) >14 days: 1/62 (1.6%) |
Mekontso Dessap 2009 [34] | 90 (79% native) | 46 (51%) | ≤7 days: 35/45 (78%) >7 days: 11/45 (24%) |
Voldstedlund 2012 [35] | 223 (85% native) | 58 (26%) | <14 days: 53/157 (33.8%) ≥14 days: 5/74 (6.7%) |
Halavaara 2019 [36] | 87 (87% native) | 19 (22%) | <14 days: 19/53 (35.8%) ≥14 days: 0/34 (0%) |
Gisler 2020 [37] | 231 (66% native) | 58 (25%) | ≤7 days: 31/60 (52%) >7 days: 27/171 (15.8%) ≤15 days: 47/125 (37.6%) >15 days: 11/96 (11.4%) ≤21 days: 53/169 (31.4%) >21 days: 5/62 (8.1%) In logistic regression analysis, contribution of antibiotic duration per 2 days on prediction of positive valve culture is absent after 21 days. Other strong predictors for positive valve cultures are Enterococcus spp. and Staphylococcus spp. |
Fillâtre 2020 [38] | 148 (81% native) | 46 (31%) | <14 days: 34/73 (46.6%) ≥14 days: 12/75 (16.0%) |
Johansson 2023 [39] | 345 (73% native) | 78 (23%) | ≤11 days: 73/208 (35.1%) >11 days: 5/137 (3.6%) |
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Kok, W. Is It Useful to Repeat Blood Cultures in Endocarditis Patients? A Critical Appraisal. Diagnostics 2024, 14, 1578. https://doi.org/10.3390/diagnostics14141578
Kok W. Is It Useful to Repeat Blood Cultures in Endocarditis Patients? A Critical Appraisal. Diagnostics. 2024; 14(14):1578. https://doi.org/10.3390/diagnostics14141578
Chicago/Turabian StyleKok, Wouter. 2024. "Is It Useful to Repeat Blood Cultures in Endocarditis Patients? A Critical Appraisal" Diagnostics 14, no. 14: 1578. https://doi.org/10.3390/diagnostics14141578