Evaluation of empirical treatment for blood culture-negative endocarditis.
Much progress has been made in understanding the main causes of blood culture-negative endocarditis (BCNE). Few studies concerning BCNE treatment (due to previous antibiotics used or fastidious pathogens) are available. We performed this study to evaluate the effectiveness of our therapeutic protocol in BCNE, based on compliance with the protocol, outcome and 1 year mortality.



We collected prospectively and analysed retrospectively cases of BCNE between 2002 and 2014, using a simplified and standardized protocol developed by our multidisciplinary team. We apply two kinds of protocols to treat BCNE, which include only four intravenous antimicrobial agents: amoxicillin, vancomycin, gentamicin and amphotericin B.



We had 177 patients with definite BCNE. There were 154 (87.0%) patients treated with both appropriate antimicrobial agents and appropriate duration of treatment. We analysed the causes of inappropriate treatment in 13 (7.3%) cases and inappropriate duration in 10 (5.6%) cases. The treatment changes were justified in all cases except one of discharge against medical advice. The fatality rate was 5.1% (nine cases) and all deaths occurred in the group of patients who were treated with appropriate treatment; however, four deaths were not attributable to empirical treatment failure. Concerning the other deaths, the lack of surgical management, in association with empirical treatment, could explain our protocol's failure, such as poorly tolerated surgery.



Our protocol is efficient and our mortality rate was low, compared with the literature review. This may result from a strategy that uses a sampling procedure and a standardized protocol at the same time.
Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France.
Estelle
E
Menu
Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France.|Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France.
Frédérique
F
Gouriet
Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France.|Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France.
Jean-Paul
JP
Casalta
Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France.|Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France.
Hervé
H
Tissot-Dupont
Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France.
Maude
M
Vecten
Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Ludivine
L
Saby
Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Sandrine
S
Hubert
Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Erwan
E
Salaun
Department of Cardiac Surgery, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Alexis
A
Theron
Department of Cardiac Surgery, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Dominique
D
Grisoli
Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Cécile
C
Lavoute
Department of Cardiac Surgery, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Frédéric
F
Collart
Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France.
Gilbert
G
Habib
Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France didier.raoult@gmail.com.|Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France.
Didier
D
Raoult
D061605:Administration, Intravenous; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D004696:Endocarditis / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000890:Anti-Infective Agents