Culture negative infective endocarditis: two decades experience at tertiary care hospital

Abstract number: 1135_112

Almohaizeie A., Alrabiah F., Al Saif S.

Objectives:  

1.  To review all culture negative Infective Endocarditis (IE), presentation and outcome.

2.  To compare medical VS surgical culture negative IE.

Methods:  

Retrospective study of all Echocardiography (echo) positive vegetations and all intraoperative findings suggestion of endocarditis. Patients confined at King Faisal Specialist Hospital and Research Center from 1985 to 2003

Results:  

Thirty-one patients satisfied the inclusion criteria. Of the 31 cases, 17 cases were identified to be native valve IE while 14 cases were prosthetic valve IE. Fifty per cent of the studied patients were male patients. Fifty-nine per cent of the cases were having rheumatic valvular diseases. The most common affected valves were mitral (71.9%), aortic (50%), and tricuspid (9.4%). Prior valvular diseases (37.5%), Prosthetic valve, (9.4%), and dental procedure (9.4%) were highly attributed risk factors to IE. Sign and symptoms available at presentation were fever (71%), new murmur (50%), Clubbing (46.9%), microscopic hematuria (18.8%), heart failure (59.4%), joint pain (25%), and splenomegaly (15.6%). Of all cases, the ECG findings were remarkable for heart block (34.4%). Echo, as TTE, was done in (90%) of the cases, in which vegetation was present in (37.5%) of the identified cases, while, valve lesion and abscess were identified in (50%) and (12.5%) of the cases, respectively. Eighty-one per cent of all patients were managed medically and surgically, while only (15%) were managed medically. Of the identified patients, (87.5%) survived IE, while (9.4%) of them died. Of interest, there was no recurrence of IE after surgery.

Conclusion:  

This study shows that mitral valve was the most affected valve in culture negative IE patients. One third of patients showed heart block. Most of the patients were managed both medically and surgically. Interestingly, of the 31 IE patients, mortality rate was shown in almost 10% of all patients.