Epidemiology
Among 17 patients with definite GNB-IE, 10 (59%) involved prosthetic valves, with 12 (70%) cases attributed to non-HACEK GNB, of which one-third were nosocomial infections [PMID:26260729].
Clinical Presentation
All patients with HACEK group GNB endocarditis experienced at least one complication, including intracardiac abscess, stroke, or other systemic embolizations [PMID:26260729].
Diagnosis
In a study of 46 patients with culture-negative infective endocarditis, PCR analysis and sequencing of heart valve samples led to a change in antibiotic regimen in 7 patients [PMID:25678629].
Management
Patients with culture-negative infective endocarditis who undergo surgery have favorable long-term outcomes comparable to those with culture-positive infective endocarditis [PMID:41147367].
All patients received antibiotic combination therapy for a median duration of 42 days, and 59% (10 patients) underwent cardiac surgery [PMID:26260729].
The study suggests that incorporating molecular diagnostic techniques, such as PCR, can significantly impact and improve antibiotic treatment strategies in culture-negative infective endocarditis [PMID:25678629].
Complications
Culture-negative infective endocarditis may indirectly impair renal function, highlighting the importance of monitoring postoperative estimated glomerular filtration rate and implementing renal-protective strategies [PMID:41147367].
Prognosis & Follow-up
Female patients with culture-negative infective endocarditis exhibit significantly worse surgical prognosis, necessitating increased clinical attention [PMID:41147367].
Key Recommendations
Based on the findings, the authors recommend performing routine molecular analysis of microorganisms in heart valve samples when preoperative culture diagnostics are inconclusive to guide therapy [PMID:25678629]. (Evidence: Expert opinion)
References
1 Zhang L, Yang S, Zhai Y, Dong Y, Zhao Y, Liu X et al.. Long-Term Prognosis and Surgical Outcomes of Culture-Negative Infective Endocarditis. Journal of the American Heart Association 2025. link 2 Loubet P, Lescure FX, Lepage L, Kirsch M, Armand-Lefevre L, Bouadma L et al.. Endocarditis due to gram-negative bacilli at a French teaching hospital over a 6-year period: clinical characteristics and outcome. Infectious diseases (London, England) 2015. link 3 Marsch G, Orszag P, Mashaqi B, Kuehn C, Haverich A. Antibiotic therapy following polymerase chain reaction diagnosis of infective endocarditis: a single centre experience. Interactive cardiovascular and thoracic surgery 2015. link