Abstract
Treatment of infective endocarditis (IE) should be initiated promptly. This might hamper the chances to identify the causative organism in blood cultures. Microbiological sampling of infected valve in patients undergoing surgery might identify the causative organism. The impact of pre-operative antimicrobial treatment on the yield of valve samples is not known. This study evaluated the impact of the duration of the pre-operative antibiotic treatment on valve culture and 16S rRNA PCR findings from resected endocardial samples. Patients meeting the modified Duke criteria of definite or possible IE and undergoing valve surgery due to IE during 2011–2016 were included from Southern Finland. Eighty-seven patients were included. In patients with shorter than 2 weeks of pre-operative antimicrobial treatment, PCR was positive in 91% (n = 42/46) and valve culture in 41% (n = 19/46) of cases. However, in patients who had 2 weeks or longer therapy before operation, PCR was positive in 53% (n = 18/34) and all valve cultures were negative. In 14% of patients, PCR had a diagnostic impact. In blood-culture negative cases (n = 13), PCR could detect the causative organism in ten patients (77%). These included five cases of Bartonella quintana, one Tropheryma whipplei, and one Coxiella burnetii. Long pre-operative antimicrobial treatment was shown to have a negative impact on microbiological tests done on resected endocardial material. After 2 weeks of therapy, all valve cultures were negative, but PCR was positive in half of the cases. PCR aided in diagnostic work-up, especially in blood culture negative cases.
Highlights
Treatment of infective endocarditis (IE) is challenging
In blood-culture negative cases, etiology may be revealed by serological testing (e.g., Bartonella quintana or Coxiella burnetii antibody assay) or, in patients undergoing valve surgery, by microbiological and molecular testing done on resected heart valves [3, 4]
Even after 2 weeks of treatment PCR detected causative agent in more than half of the cases. 16S rRNA PCR contributed to the etiological diagnosis in 14% of cases
Summary
Treatment of infective endocarditis (IE) is challenging. It demands skills from different medical and surgical specialties and necessitates promptly initiated and prolonged intravenous. Division of Clinical Microbiology, HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland The effect of antimicrobial treatment duration on diagnostic yield of valve culture or PCR has not been characterized [6,7,8,9,10,11]
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