Diagnosis of blood XXXX and clinical comparison between blood culture-negative and blood culture-positive cases.

@entity1 @entity712 @entity794 @entity887 @entity4003 @entity884
PURPOSE: To analyze the clinical characteristics of blood @entity884 (BCNE) and how it compares to those of blood culture-positive @entity884 (BCPE) cases and show how molecular tools helped establish the etiology in BCNE. METHODS: Adult @entity1 with @entity884 (IE) and having valve surgery were included. Valves were studied by polymerase chain reaction (PCR). Statistical analysis compared BCNE and BCPE. RESULTS: One hundred and thirty-one @entity1 were included; 53 (40  %) had BCNE. The mean age was 45      16  years; 33 (62  %) were male. BCNE was community-acquired in 41 (79  %). Most @entity1 were referred from other hospitals (38, 73  %). Presentation was subacute in 34 (65  %), with fever in 47/53 (90  %) and a new regurgitant murmur in 34/42 (81  %). Native valves were affected in 74  %, mostly left-sided. All echocardiograms showed major criteria for IE. Antibiotics were used prior to BC collection in 31/42 (74  %). Definite histological diagnosis was established for 35/50 (70  %) valves. PCR showed oralis group streptococci in 21 (54  %), @entity794 in 3 (7.7  %), gallolyticus group streptococci in 2 (5.1  %), @entity4003 in 1 (2.5  %) and Rhizobium sp. in 1 (2.5  %). In-hospital mortality was 9/53 (17  %). Fever (p  =  0.06, OR 4.7, CI 0.91-24.38) and @entity887 (p  =  0.003, OR 3.3, CI 1.55-6.82) were more frequent in BCPE cases, while new acute regurgitation (p  =  0.05, OR 0.3, CI 0.098-0.996) and @entity712 (p  =  0.02, OR 0.3, CI 0.13-0.79) were less so. CONCLUSIONS: BCNE resulted mostly from prior antibiotics and was associated with severe hemodynamic compromise. Valve histopathology and PCR were useful in confirming the diagnosis and pointing to the etiology of BCNE.
