Long-Term Prognosis and Surgical Outcomes of Culture-Negative Infective Endocarditis

  1. Lanlin Zhang
  2. Sheng Yang
  3. Yuanhang Zhai
  4. Yuheng Dong
  5. Guotao Ma
  6. Xinrong Liu
  7. Chaoji Zhang
  8. Shangdong Xu
  9. Jun Zheng
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Abstract

Background

Culture-negative infective endocarditis (CNIE) presents significant diagnostic and therapeutic challenges due to the absence of identifiable pathogens, leading to empirical antibiotic treatment and potentially worse clinical outcomes. This study aims to compare the clinical characteristics, surgical outcomes, and long-term prognosis of CNIE and culture-positive infective endocarditis (CPIE) patients.

Methods

A total of 698 patients who underwent surgery for infective endocarditis (IE) were included, with 154 (22.1%) classified as CNIE and 544 (77.9%) as CPIE. Baseline characteristics, preoperative risk factors, intraoperative variables, and postoperative outcomes were analyzed.

Results

CNIE patients exhibited significantly worse preoperative cardiac and renal function. Multivariate analysis identified female, perivalvular abscess and renal insufficiency are independent risk factors for early mortality in IE patients. Postoperatively, CNIE patients had a higher incidence of continuous renal replacement therapy (18% vs. 9%, p<0.01). Although long-term follow-up data showed no significant difference in the overall prognosis between CNIE and CPIE patients, subgroup analysis found that female CNIE patients showed worse long-term prognosis (HR=2.46 [1.16-5.23]; P=0.02).

Conclusions

Although the survival rates of CNIE and CPIE are similar, the prognosis of female CNIE patients is significantly worse.

Clinical Perspective

  • Culture-negative infective endocarditis (CNIE) patients who undergo surgery have favorable long-term outcomes comparable to culture-positive infective endocarditis (CPIE) patients, emphasizing the pivotal role of surgical intervention in infective endocarditis treatment.

  • Female CNIE patients exhibit significantly worse surgical prognosis, highlighting the need for increased clinical attention and efforts to identify pathogens using other methods like tissue culture, PCR and mNGS.

  • Although overall prognosis is similar, CNIE may indirectly worsen outcomes by impairing renal function, underscoring the importance of postoperative eGFR monitoring and protect kidney function.

Article activity feed

  1. Version published to 10.1101/2025.05.28.25328538v1 on medRxiv