title: Community-acquired culture-negative endocarditis: clinical characteristics and risk factors for mortality.
abstract: OBJECTIVE
  We studied the clinical characteristics, in-hospital mortality, and long-term prognosis of patients with culture-negative endocarditis.
  
  
  METHODS
  In total, 221 episodes of definite endocarditis were studied (2004-2009). We compared the clinical, laboratory, and echocardiography characteristics and the survival rates of patients with culture-negative and culture-positive endocarditis. Survival after hospital discharge was evaluated using the Kaplan-Meier method and coefficient of mortality comparisons.
  
  
  RESULTS
  Culture-negative endocarditis occurred in 51/221 (23.1%) episodes. Compared with the culture-positive endocarditis patients, the time elapsed between admission and initiation of antibiotic therapy was longer in patients with culture-negative endocarditis (p<0.001), and these patients also had lower C-reactive protein levels at admission (p<0.001). In-hospital mortality rates were not different between culture-negative and culture-positive patients. After hospital discharge, there was also no significant difference between groups in survival curves (p=0.471). Severe sepsis (adjusted prevalence ratio 3.32, p=0.010) and diabetes mellitus (adjusted prevalence ratio 2.32, p=0.009) were independently associated with in-hospital death in culture-negative patients.
  
  
  CONCLUSIONS
  Culture-negative endocarditis patients presented with lower levels of C-reactive protein at admission and required more time for initiation of antibiotic therapy, although there was no difference in in-hospital mortality or long-term survival between culture-negative and culture-positive endocarditis patients. Diabetes mellitus and severe sepsis were associated with in-hospital death in patients with culture-negative endocarditis.
authors: Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, Sao Paulo, SP 05403-000, Brazil. Electronic address: rinaldo_focaccia@uol.com.br.
authors: Rinaldo Focaccia
authors: RF
authors: Siciliano
authors: Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, Sao Paulo, SP 05403-000, Brazil.
authors: Alfredo Jose
authors: AJ
authors: Mansur
authors: Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, Sao Paulo, SP 05403-000, Brazil.
authors: Jussara Bianchi
authors: JB
authors: Castelli
authors: Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, Sao Paulo, SP 05403-000, Brazil.
authors: Vanessa
authors: V
authors: Arias
authors: Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, Sao Paulo, SP 05403-000, Brazil.
authors: Max
authors: M
authors: Grinberg
authors: Division of Infectious Diseases, Drexel University College of Medicine, Philadelphia, USA.
authors: Matthew E
authors: ME
authors: Levison
authors: Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, Sao Paulo, SP 05403-000, Brazil.
authors: Tania Mara Varejao
authors: TM
authors: Strabelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections; D015897:Comorbidity; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
keywords: Endocarditis; Mortality; Risk factor