Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry
Authors: Kong William K F , Salsano Antonio , Giacobbe Daniele Roberto , Popescu Bogdan A , Laroche Cécile , Duval Xavier , Schueler Robert , Moreo Antonella , Colonna Paolo , Piper Cornelia , Calvo-Iglesias Francisco , Badano Luigi P , Srdanovic Ilija , Boutoille David , Huttin Olivier , Stöhr Elisabeth , Timóteo Ana Teresa , Vaskelyte Jolanta Justina , Sadeghpour Anita , Tornos Pilar , Abid Leila , Poh Kian Keong , Habib Gilbert , Lancellotti Patrizio ,   the EURO-ENDO Investigators, Habib Gilbert , Lancellotti Patrizio , Cosyns Bernard , Donal Erwan , Erba Paola , Habib Gilbert , Iung Bernard , Maggioni Aldo P , Popescu Bogdan A , Prendergast Bernard , Tornos Pilar , Tatar-Chentir Nora Nabila Ali , Al-Mallah Mouaz , Aneq Meriam Astrom , Athanassopoulos George , Badano Luigi Paolo , Benyoussef Soraya , Aranda Erick Calderon , Cardim Nuno Miguel , Chan Kwan-Leung , Cosyns Bernard , Cruz Ines , Edvardsen Thor , Goliasch Georg , Habib Gilbert , Hagendorff Andreas , Hristova Krasimira , Iung Bernard , Kamp Otto , Kang Duk-Hyun , Kong William , Matskeplishvili Simon , Meshaal Marwa , Mirocevic Maja , Neskovic Aleksandar N , Pazdernik Michal , Plonska-Gosciniak Edyta , Popescu Bogdan A , Prendergast Bernard , Raissouni Maha , Ronderos Ricardo , Sade Leyla Elif , Sadeghpour Anita , Sambola Antonia , Sengupta Shantanu , Separovic-Hanzevacki Jadranka , Takeuchi Masaaki , Tucay Edwin , Rodrigues Ana Clara Tude , Varga Albert , Vaskelyte Jolanta , Yamagata Kentaro , Yiangou Kyriakos , Zaky Hosam , Ronderos R , Avegliano G , Fernandez Oses P , Filipini E , Granada I , Iribarren A , Mahia M , Nacinovich F , Ressi S , Obregon R , Bangher M , Dho J , Cartasegna L , Plastino ML , Novas V , Shigel C , Reyes G , De Santos M , Gastaldello N , Granillo Fernandez M , Potito M , Streitenberger G , Velazco P , Casabé JH , Cortes C , Guevara E , Salmo F , Seijo M , Weidinger F , Heger M , Brooks R , Stöllberger C , Ho C-Y , Perschy L , Puskas L , Goliasch G , Binder C , Rosenhek R , Schneider M , Winter M-P , Hoffer E , Melissopoulou M , Lecoq E , Legrand D , Jacquet S , Massoz M , Lancellotti P , Pierard L , Dulgheru R , Marchetta S , D´Emal C , Oury C , Cosyns B , Droogmans S , Kerkhove D , Motoc A , Plein D , Roosens B , Soens L , Weytjens C , Lemoine I , Rodrigus I , Paelinck B , Amsel B , Unger P , Konopnicki D , Beauloye C , Pasquet A , Pierard S , Vancraeynest D , Vanoverschelde JL , Sinnaeve F , Andrade JL , Tude Rodrigues AC , Staszko K , Dos Santos Monteiro R , Miglioranza MH , Shuha DL , Alcantara M , Cravo V , Fazzio L , Felix A , Iso M , Musa C , Siciliano AP , Villaca Filho F , Braga J , Rodrigues A , Silva R , Vilela F , Rodrigues D , Silva L , Morhy S , Fischer C , Silva R , Vieira M , Afonso T , Abreu J , Falcao SN , Moises V , Gouvea A , João G , Mancuso F , Silva C , Souza AC , Abboud CS , Bellio de Mattos Barretto R , Ramos A , Arnoni R , Assef JE , Della Togna DJ , Le Bihan D , Miglioli L , Romero Oliveira AP , Tadeu Magro Kroll R , Cortez D , Gelape CL , Peirira Nunes MdC , De Abreu Ferrari TC , Chan K-L , Hay K , Le V , Page M , Poulin F , Sauve C , Serri K , Mercure C , Beaudoin J , Pibarot P , Sebag I , Rudski L , Ricafort G , Barsic B , Krajinovic V , Vargovic M , Separovic-Hanzevacki J , Lovric D , Reskovic-Luksic V , Vincelj J , Jaksic Jurinjak S , Yiannikourides V , Ioannides M , Kyriakou C , Pofaides C , Masoura V , Yiangou K , Pudich J , Linhart A , Siranec M , Marek J , Blechova K , Kamenik M , Pazdernik M , Pelouch R , Coufal Z , Mikulica M , Griva M , Jancova E , Mikulcova M , Taborsky M , Precek J , Jecmenova M , Latal J , Widimsky J , Butta T , Machacek S , Vancata R , Spinar J , Holicka M , Pow Chon Long F , Anzules N , Bajana Carpio A , Largacha G , Penaherrera E , Moreira D , Mahfouz E , Elsafty E , Soliman A , Zayed Y , Aboulenein J , Abdel-Hay M , Almaghraby A , Abdelnaby M , Ahmed M , Hammad B , Saleh Y , Zahran H , Elgebaly O , Saad A , Ali M , Zeid A , El Sharkawy R , Meshaal M , Al Kholy A , Doss R , Osama D , Rizk H , Elmogy A , Mishriky M , Assayag P , El Hatimi S , Botelho-Nevers E , Campisi S , Fuzellier J-F , Gagneux-Brunon A , Pierrard R , Tulane C , Detoc M , Mehalla T , Boutoille D , Al Habash O , Asseray-Madani N , Biron C , Brochard J , Caillon J , Cueff C , Le Tourneau T , Lecompte AS , Lecomte R , Lefebvre M , Magali Michel MM , Pattier S , Delarue S , Le Bras M , Orain J , Faucher J-F , Aboyans V , Beeharry A , Durox H , Lacoste M , Magne J , Mohty D , David A , Pradel V , Sierra V , Neykova A , Bettayeb B , Elkentaoui S , Tzvetkov B , Landry G , Strady C , Ainine K , Baumard S , Brasselet C , Tassigny C , Valente-Pires V , Lefranc M , Hoen B , Lefevre B , Curlier E , Callier C , Fourcade N , Jobic Y , Ansard S , Le Berre R , Le Roux P , Le Ven F , Pouliquen M-C , Prat G , Bouchart F , Savoure A , Alarcon C , Chapuzet C , Gueit I , Tribouilloy C , Bohbot Y , Peugnet F , Gun M , Iung B , Duval X , Lescure X , Ilic-Habensus E , Sadoul N , Selton-Suty C , Alla F , Chevalier E , Goehringer F , Huttin O , Garcia R , Le Marcis V , Tattevin P , Donal E , Flecher E , Revest M , Habib G , Hubert S , Casalta J-P , Gouriet F , Arregle F , Cammilleri S , Tessonnier L , Riberi A , Chirouze C , Bouiller K , Brunel A-S , Fournier D , Hustache-Mathieu L , Klopfenstein T , Moreau J , Lim P , Oliver L , Ternacle J , Moussafeur A , Chavanet P , Piroth L , Buisson M , Mahy S , Martins C , Salmon-Rousseau A , Gohier S , Piper C , Börgermann J , Guckel D , Horstkotte D , Brockmeier B , Winkelmann E , Hagendorff A , Grey D , Nickenig G , Schueler R , Öztürk C , Stöhr E , Hamm C , Walther T , Brandt R , Frühauf A-C , Hartung CT , Hellner C , Wild C , Becker M , Hamada S , Kaestner W , Stangl K , Knebel F , Baldenhofer G , Brecht A , Dreger H , Isner C , Pfafflin F , Stegemann M , Zahn R , Fraiture B , Kilkowski C , Karcher A-K , Klinger S , Tolksdorf H , Tousoulis D , Aggeli C , Sarri G , Sideris S , Venieri E , Athanassopoulos G , Tsiapras D , Armenis I , Koutsiari A , Floros G , Grassos C , Dragasis S , Rallidis L , Varlamos C , Michalis L , Naka K , Bechlioulis A , Kotsia A , Lakkas L , Pappas K , Papadopoulos C , Kiokas S , Lioni A , Misailidou S , Barbetseas J , Bonou M , Kapelios C , Tomprou I , Zerva K , Manolis A , Hamodraka E , Athanasiou D , Haralambidis G , Poulimenos L , Samaras H , Nagy A , Bartykowszki A , Gara E , Sengupta S , Mungulmare K , Kasliwal R , Bansal M , Bhan A , Ranjan S , Kyavar M , Maleki M , Noohi Bezanjani F , Sadeghpour A , Alizadehasl A , Boudagh S , Ghavidel A , Moradnejad P , Pasha HR , Ghadrdoost B , Gilon D , Strahilevitz J , Israel S , Wanounou M , d'Agostino C , Colonna P , De Michele L , Fumarola F , Stante M , Marchionni N , Scheggi V , Alterini B , Del Pace S , Stefano P , Sparano C , Badano LP , Muraru D , Ruozi N , Tenaglia R , Limbruno U , Cresti A , Baratta P , Solari M , Giannattasio C , Moreo A , De Chiara B , Lopez Montero B , Musca F , Orcese CA , Panzeri F , Russo CF , Spano F , Alfieri O , De Bonis M , Agricola E , Busnardo E , Carletti S , Castiglioni B , Chiappetta S , Del Forno B , Ferrara D , Guffanti M , Iaci G , Lapenna E , Nisi T , Oltolini C , Pajoro U , Pasciuta R , Ripa M , Scarpellini P , Tassan Din C , Meneghin R , Schiavi D , Piscione F , Citro R , Benvenga RM , Greco L , Prota C , Radano I , Soriente L , Bellino M , Di Vece D , Santini F , Salsano A , Olivieri GM , Turrini F , Messora R , Tondi S , Olaru A , Agnoletto V , Grassi L , Leonardi C , Sansoni S , Del Ponte S , Actis Dato GM , De Martino A , Ohte N , Kikuchi S , Wakami K , Aonuma K , Seo Y , Ishizu T , Machino-Ohtsuka T , Yamamoto M , Iida N , Nakajima H , Nakagawa Y , Izumi C , Amano M , Miyake M , Takahashi K , Shiojima I , Miyasaka Y , Maeba H , Suwa Y , Taniguchi N , Tsujimoto S , Kitai T , Ota M , Yuda S , Sasaki S , Hagiwara N , Yamazaki K , Ashihara K , Arai K , Saitou C , Saitou S , Suzuki G , Shibata Y , Watanabe N , Nishino S , Ashikaga K , Kuriyama N , Mahara K , Abe K , Fujimaki H , Okubo T , Shitan H , Takanashi S , Terada M , Yamamoto H , Sata M , Yamada H , Kusunose K , Saijo Y , Seno H , Yuichiro O , Sakata Y , Mizuno H , Nakatani S , Onishi T , Sengoku K , Sera F , Park SW , Eun Kyoung K , Ga Yeon L , Hwang J-w , Jin-Oh C , Park S-J , Sang-Chol L , Sung-A C , Jang SY , Kang D-H , Heo R , Lee S , Song J-M , Jung E , Plisiene J , Dambrauskaite A , Gruodyte G , Jonkaitiene R , Vaskelyte J , Mizariene V , Atkocaityte J , Zvirblyte R , Sow R , Codreanu A , De la Vega ECL , Michaux C , Staub T , Jacobs-Orazi L , Mallia Azzopardi C , Xuereb RG , Piscopo T , Borg D , Casha R , Farrugia J , Fenech M , Pllaha E , Vella C , Yamagata K , Grib L , Raevschi E , Grejdieru A , Balan G , Cardaniuc I , Cardaniuc L , Corcea V , Feodorovici A , Gaina V , Girbu L , Jimbei P , Kravcenco D , Panfile E , Prisacari E , Samohvalov E , Samohvalov S , Sceglova N , Benesco I , Marian V , Sumarga N , Mirocevic M , Bozovic B , Bulatovic N , Lakovic P , Music L , Roos-Hesselink J , Budde R , Gamela T , Wahadat A , Kamp O , Meijers T , Van Melle JP , Deursen VM , Crijns H , Bekkers S , Cheriex E , Gilbers M , Kietselaer B , Knackstedt C , Lorusso R , Schalla S , Streukens S , Chamuleau S , Cramer M-J , Teske A , Van der Spoel T , Wind A , Liesbek O , Lokhorst J , Van Heusden H , Tanis W , Van der Bilt I , Vriend J , De Lange-van Bruggen H , Karijodikoro E , Riezebos R , van Dongen E , Schoep J , Stolk V , Axler O , Baumann F , Lebras S , Edvardsen T , Offstad JT , Beitnes JO , Helle-Valle T , Skulstad H , Skardal R , Qamar N , Furnaz S , Ahmed B , Butt MH , Khanzada MF , Saghir T , Wahid A , Hryniewiecki T , Szymanski P , Marzec K , Misztal-Ogonowska M , Kosmala W , Przewlocka-Kosmala M , Rojek A , Woznicka K , Zachwyc J , Lisowska A , Kaminska M , Kasprzak J , Kowalczyk E , Strzecka DF , Wejner-Mik P , Trabulo M , Freitas P , Ranchordas S , Rodrigues G , Pinto P , Queiros C , Azevedo J , Marques L , Seabra D , Branco L , Abreu J , Cruz M , Galrinho A , Moreira R , Rio P , Timoteo AT , Selas M , Cardim NM , Carmelo V , Duque Neves B , Pereira H , Cruz I , Guerra A , Marques A , Pintassilgo I , Tomescu MC , Trofenciuc N-M , Andor M , Bordejevic A , Branea HS , Caruntu F , Cirin L , Citu IM , Cotoraci CA , Darabantiu D , Farcas R , Marincu I , Mavrea A , Onel MF , Parvanescu T , Pop D , Pop-Moldovan AL , Puticiu MI , Velcean LA , Ionac A , Cozma D , Mornos C , Goanta F , Popescu I , Beyer R , Mada R , Rancea R , Rosianu H , Tomoaia R , Stanescu C , Kobalava Z , Karaulova J , Kotova E , Milto A , Pisaryuk A , Povalyaev N , Sorokina M , Alrahimi J , Elshiekh A , Jamiel A , Ahmed A , Al-Mallah M , Attia N , Putnikovic B , Neskovic A , Dimic A , Ivanovic B , Matic S , Trifunovic D , Petrovic J , Kosevic D , Dabic P , Milojevic P , Petrovic I , Stojanovic I , Srdanovic I , Kovacevic M , Redzek A , Stefanovic M , Susak S , Velicki L , Vulin A , Yeo TC , KF Kong W , Poh KK , Vilacosta I , Abd El- Nasser M , Ferrera C , Olmos C , Calvo Iglesias F , Blanco-Gonzalez E , Bravo Amaro M , Germinas AN , Lopez-Rodriguez E , Lugo Adan J , Pazos-Lopez P , Pereira Loureiro M , Perez MT , Raposeiras-Roubin S , Rasheed Yas S , Suarez-Varela M-M , Vasallo Vidal F , Garcia-Dorado D , Sambola A , Fernandez-Hidalgo N , Gonzalez-Alujas T , Lozano J , Maisterra O , Pizzi N , Rios R , Tornos P , Bayes-Genis A , Pedro Botet L , Vallejo N , Berastegui E , Llibre C , Mateu L , Nunez R , Quesada D , Bosch Portell D , Aboal Vinas J , Albert Bertran X , Brugada Tarradellas R , Loma-Osorio Ricon P , Tiron de Llano C , Arnau MA , Bel A , Blanes M , Osa A , Anguita M , Carrasco F , Castillo J , Zamorano JL , Moya Mur JL , Alvaro M , Fernandez-Golfin C , Monteagudo JM , Navas Elorza E , Farinas Alvarez MC , Aguero Balbin J , Arminanzas C , Arnaiz de las Revillas F , Arnaiz Garcia A , Cobo Belaustegui M , Fernandez Sampedro M , Gutierrez Cuadra M , Gutierrez-Diez JF , Zarauza J , Garcia Cuello L , Gonzalez Rico C , Rodriguez-Alvarez R , Goikoetxea J , Montejo M , Miro J , Almela M , Ambrosioni J , Falces C , Fuster D , Garcia-de-la-Maria C , Hernandez-Meneses M , Llopis J , Marco F , Moreno A , Quintana E , Sandoval E , Tellez A , Tolosana JM , Vidal B , Ruiz-Zamora I , Bardaji Ruiz A , Sanz Girgas E , Garcia-Pardo G , Guillen Marzo M , Rodriguez Oviedo A , Villares Jimenez A , Abid L , Hammami R , Kammoun S , Mourali MS , Mghaieth Zghal F , Ben Hlima M , Boudiche S , Ouali S , Zakhama L , Antit S , Slama I , Gulel O , Sahin M , Sade LE , Karacaglar E , Kucukoglu S , Cetinarslan O , Yasar US , Canpolat U , Mutlu B , Atas H , Dervishova R , Ileri C , Zaky H , Alhashmi J , Baslib F , Tahir J , Zarger P , Woldman S , Menezes L , Primus C , Uppal R , Bvekerwa I , Chandrasekaran B , Kopanska A , Prendergast B , Cannata S , Chambers J , Hancock J , Klein J , Rajani R , Ursi MP , Dworakowski R , Fife A , Breeze J , Browne-Morgan M , Gunning M , Streather S , Asch F , Zemedkun M , Alyavi B , Uzokov J 
Published: June 2022

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.