Abstract
Background
Infective endocarditis (IE) is a severe disease. Pathogen isolation is fundamental so as to treat effectively and reduce morbidity and mortality. Blood and valve culture and histopathology (HP) are routinely employed for this purpose. Valve HP is the gold standard for diagnosis.
Objectives
To determine the sensitivity and specificity of clinical criteria for IE (the modified Duke and the St Thomas’ minor modifications, STH) of blood and valve culture compared to valve HP, and to evaluate antibiotic treatment duration.
Methods
Prospective case series of patients, from 2006 to 2014 with surgically treated IE. Statistical analysis was done by the R software.
Results
There were 136 clinically definite episodes of IE in 133 patients. Mean age ± SD was 43 ± 15.6 years and IE was left sided in 81.6 %. HP was definite in 96 valves examined, which were used as gold standard. Sensitivity of blood culture was 61 % (CI 0.51, 0.71) and of valve culture 15 % (CI 0.07, 0.26). The modified Duke criteria were 65 % (CI 0.55, 0.75) sensitive and 33 % specific, while the STH’s sensitivity was 72 % (CI 0.61, 0.80) with similar specificity. In multivariate analysis and logistic regression, the only variable with statistical significance was duration of antibiotic therapy postoperatively.
Conclusions
Valve HP had high sensitivity and valve culture low sensitivity in the diagnosis of IE. The STH’s criteria were more sensitive than the modified Duke criteria. Valve HP should guide duration of postoperative antibiotic treatment.
Similar content being viewed by others
References
Habib G, Lancellotti P, Antunes MJ, et al. ESC guidelines for the management of infective endocarditis. The task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Eur Heart J. 2015;36:3075–128.
Baddour LM, Wilson W, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications. A scientific statement for healthcare professionals from the American Heart Association. Endorsed by the Infectious Diseases Society of America. Circulation. 2015;132:1435–86.
Murdoch DR, Corey RG, Hoen B, et al. Clinical Presentation, Etiology and Outcome of Infective Endocarditis in the 21st Century: the international collaboration on endocarditis-prospective cohort study. Arch Intern Med. 2009;169:463–73.
Dayer MJ, Jones S, Prendergast B, et al. Incidence of infective endocarditis in England, 2000–13: a secular trend, interrupted time-series analysis. Lancet. 2015;385:1219–28.
Pant S, Patel NJ, Deshmukh A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015;65:2070–6.
Tattevin P, Watt G, Revest M, et al. Update on blood culture-negative endocarditis. Med Mal Infect. 2015;45:1–8.
Fournier PE, Thuny F, Richet H, et al. Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis. 2010;51:131–40.
De Paula DHG, Tura BR, Lamas CC. Adverse events related to intravenous antibiotic therapy: a prospective observational study in the treatment of infective endocarditis. BMJ Open. 2012;2:e001189.
Muñoz P, Bouza E, Marín M, et al. Heart valves should not be routinely cultured. J Clin Microbiol. 2008;46:2897–901.
Greub G, Lepidi H, Rovery C, et al. Diagnosis of infectious endocarditis in patients undergoing valve surgery. Am J Med. 2005;118:230–8.
Lepidi H, Durack DT, Raoult D. Diagnostic methods current best practices and guidelines for histologic evaluation in infective endocarditis. Infect Dis Clin N Am. 2002;16:336–9.
Lamas CC, Eykyn SJ. Blood culture negative endocarditis: analysis of 63 cases presenting over 25 years. Heart. 2003;89:258–62.
Lamas CC. Diagnostic strategy for blood culture—negative endocarditis. Clin Infect Dis. 2010;51:141–2.
Lamas CC, Fournier PE, Zappa M, et al. Diagnosis of blood culture-negative endocarditis and clinical comparison between blood culture-negative and blood culture-positive cases. Infection. 2015;. doi:10.1007/s15010-015-0863-x.
Harris KA, Yam T, Jalili S, et al. Service evaluation to establish the sensitivity, specificity and additional value of broad-range rDNA PCR for the diagnosis of infective endocarditis from resected endocardial material in patients from eight UK and Ireland hospitals. Eur J Clin Microbiol Infect Dis. 2014;33:2061–6.
Breitkopf C, Dieter Hammel, Scheld HH, et al. Impact of a molecular approach to improve the microbiological diagnosis of infective heart valve endocarditis. Circulation. 2005;111:1415–142117.
Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.
Lamas CC, Eykyn SJ. Suggested modifications to the duke criteria for the clinical diagnosis of native valve and prosthetic valve endocarditis: analysis of 118 pathologically proven cases. Clin Infect Dis. 1997;25:713–9.
Edouard S, Nabet C, Lepidi H, et al. Bartonella, a common cause of endocarditis: a report on 106 cases and review. J Clin Microbiol. 2015;53:824–9.
Morris AJ, Drinkovic D, Pottumarthy S, et al. Gram stain, culture, and histopathological examination findings for heart valves removed because of infective endocarditis. Clin Infect Dis. 2003;36:697–704.
Morris AJ, Drinković D, Pottumarthy S, MacCulloch D, Kerr AR, West T. Bacteriological outcome after valve surgery for active infective endocarditis: implications for duration of treatment after surgery. Clin Infect Dis. 2005;41:187–93.
Shrestha NK, Ledtke CS, Wang H, et al. Heart valve culture and sequencing to identify the infective endocarditis pathogen in surgically treated patients. Ann Thorac Surg. 2015;99:33–7.
Renzulli A, Carozza A, Marra C, et al. Are blood and valve cultures predictive for long-term outcome following surgery for infective endocarditis? Eur J Cardiothorac Surg. 2000;17:228–33.
Leone S, Ravasio V, Durante-Mangoni E, et al. Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis. Infection. 2012;40:527–35.
Nadji G, Rusinaru D, Remadi JP, et al. Heart failure in left-sided native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment. Eur J Heart Fail. 2009;11:668–75.
Gaca JG, Sheng S, Daneshmand MA, et al. Outcomes for endocarditis surgery in North America: a simplified risk scoring system. J Thorac Cardiovasc Surg. 2011;141:98–106.
Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41:734–44.
Chu V, Cabell C, Benjamin D, et al. Early predictors of in-hospital death in infective endocarditis. Circulation. 2004;109:1745–9.
Chu V, Park L, Athan E, et al. Association between surgical indications, operative risk and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis. Circulation. 2015;131:131–40.
Acknowledgments
Dr. Cristiane Lamas has received a personal grant from FUNADESP/Unigranrio in support for this research, and also from FAPERJ, Rio de Janeiro, Brazil.
Dr. Carolina Januário-da-Silva received a student grant from FAPERJ, Rio de Janeiro, Brazil.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Brandão, T.J.D., Januario-da-Silva, C.A., Correia, M.G. et al. Histopathology of valves in infective endocarditis, diagnostic criteria and treatment considerations. Infection 45, 199–207 (2017). https://doi.org/10.1007/s15010-016-0953-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-016-0953-4