Infective endocarditis: Improving the diagnostic yield

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dc.contributor.authorKoegelenberg C.F.N.
dc.contributor.authorDoubell A.F.
dc.contributor.authorOrth H.
dc.contributor.authorReuter H.
dc.date.accessioned2011-05-15T16:15:54Z
dc.date.available2011-05-15T16:15:54Z
dc.date.issued2004
dc.description.abstractIntroduction: Isolating aetiological agents in patients with infective endocarditis (IE) remains problematical. We postulated that the high local incidence of culture-negative IE resulted from antibiotic exposure prior to blood cultures and that a structured delay in therapy in the subacute presentation would improve the diagnostic yield. Aim: We aimed to prospectively observe the diagnostic approach and give an overview of supplementary laboratory tests. Study design: Patients with suspected IE were enrolled into this analytical observational study and followed up for six months (n = 92). We compared the diagnostic yield and outcome in cases where antibiotics were withheld for 72 hours, with those cases who received early antimicrobials, despite being deemed safe for delayed therapy. Results: Definitive diagnoses (definite or excluded IE) were made in 92.8% of patients where antibiotics were delayed, compared to 60% of patients who received empirical treatment (p = 0.08). The mortality rates were 18.4% and 30.0% respectively (p = 0.18). Twenty-three of 26 patients with definite culture-negative IE received antibiotics during the 48 hours preceding cultures, compared to eight of 21 culture-positive patients (P < 0.001). Screening for atypical bacteria did not improve the yield. C-reactive protein (CRP) had a sensitivity of 97.9% (negative predictive value 87.5%), whereas a positive rheumatoid factor (RF) had a specificity of 93.8% (positive predictive value 91.7%). Conclusions: We observed tendencies towards a greater diagnostic yield and lower mortality where antibiotics were initially withheld. Antibiotics prior to blood cultures were an important cause of culture-negative IE. A normal CRP proved useful in excluding IE; a positive RF strongly favoured IE.
dc.description.versionArticle
dc.identifier.citationCardiovascular Journal of South Africa
dc.identifier.citation15
dc.identifier.citation1
dc.identifier.issn10159657
dc.identifier.urihttp://hdl.handle.net/10019.1/13539
dc.subjectC reactive protein
dc.subjectrheumatoid factor
dc.subjectadult
dc.subjectantibiotic therapy
dc.subjectarticle
dc.subjectbacterial endocarditis
dc.subjectblood culture
dc.subjectdiagnostic approach route
dc.subjecthuman
dc.subjectlaboratory diagnosis
dc.subjectlaboratory test
dc.subjectmajor clinical study
dc.subjectmortality
dc.subjectAnti-Bacterial Agents
dc.subjectBiological Markers
dc.subjectC-Reactive Protein
dc.subjectDiagnosis, Differential
dc.subjectEndocarditis, Bacterial
dc.subjectFollow-Up Studies
dc.subjectGram-Negative Bacteria
dc.subjectGram-Negative Bacterial Infections
dc.subjectGram-Positive Bacteria
dc.subjectGram-Positive Bacterial Infections
dc.subjectHumans
dc.subjectIncidence
dc.subjectMitral Valve Prolapse
dc.subjectPredictive Value of Tests
dc.subjectProspective Studies
dc.subjectRheumatic Heart Disease
dc.subjectRheumatoid Factor
dc.subjectSensitivity and Specificity
dc.subjectSouth Africa
dc.subjectSurvival Analysis
dc.titleInfective endocarditis: Improving the diagnostic yield
dc.typeArticle
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