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culture-negative endocarditis
Etiology:
- receipt of antibiotics before obtaining blood cultures (most common)
- Bartonella
- Coxiella burnetti
- Brucella
- fungi
Laboratory:
- blood cultures, 2 sets from different venipuncture sites
- when cultures have remained negative for 72 hours, serologic testing for Coxiella, Bartonella, Brucella, fungal pathogens
- microbial cell-free DNA assays with sequencing
- obtain samples before or as early as possible after initiation of antibiotics
- in cardiac surgery cases, valve tissue should be sent out for bacterial, fungal, & mycobacterial cultures & assessment of microbial ribosomal RNA
- urinalysis:
- may show hematuria & pyruria of immune-complex glomerulonephritis
- rheumatoid factor may be positive
Radiology:
- transthoracic echocardiogram
- transesophageal echocardiogram if holosytolic murmur of mitral regurgitation
- 18F-FdG PET in n cases with uncertain infectious etiology
Management:
- empiric therapy against methicillin-susceptible staphylococci, streptococci, & enterococci
General
endocarditis
References
- NEJM Knowledge+ Complex Medical Care
- DeSimone DC et al.
Blood culture-negative endocarditis: A scientific statement from the American
Heart Association.
J Am Heart Assoc 2025 Apr 15; 14:e040218
PMID: 40094211 Free article
https://www.ahajournals.org/doi/10.1161/JAHA.124.040218