Author + information
- Received October 2, 2019
- Revision received March 30, 2020
- Accepted April 28, 2020
- Published online June 29, 2020.
- Valentin Gisler, MDa,b,
- Sarah Dürr, MDc,
- Irina Irincheeva, PhDd,
- Andreas Limacher, PhDd,
- Sara Droz, PharmDe,
- Thierry Carrel, MDf,
- Lars Englberger, MDf,∗ and
- Parham Sendi, MDe,∗∗ (, )@ParhamSendi
- aDepartment of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- bDivision of Infectious Diseases and Hospital Hygiene, Cantonal Hospital Aarau, Aarau, Switzerland
- cMedical Faculty, University of Bern, Bern, Switzerland
- dCTU Bern, University of Bern, Bern, Switzerland
- eInstitute for Infectious Diseases, University of Bern, Bern, Switzerland
- fDepartment of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
- ↵∗Address for correspondence:
Dr. Parham Sendi, University of Bern, Institute for Infectious Diseases, Friedbühlstrasse 51, 3001 Bern, Switzerland.
Background Bacterial growth in cultures of resected heart valves of patients with infective endocarditis (IE) is influenced by pre-operative antibiotic treatment (preop-AT).
Objectives This study sought to evaluate the time dependency of valve culture results (positive valve culture [PVC] vs. negative valve culture) on preop-AT.
Methods A total of 352 IE episodes in 344 adult patients of our tertiary referral hospital were retrospectively investigated (2005 to 2016). The primary endpoint was PVC results. The study used a logistic additive model adjusted for bacterial species, the McCabe-Jackson classification, and the existence of foreign valve material as covariables.
Results The 231 included IE cases (187 [81%] men, median age 62 years, 153 [66%] native valves) comprised 58 (25%) PVC results and 173 (75%) negative valve culture results. A multivariable analysis adjusted for bacterial species, McCabe-Jackson classification, and valve type resulted in odds ratios for PVC of 6.35 (95% confidence interval [CI]: 1.94 to 20.78; p = 0.002) and 3.93 (95% CI: 1.57 to 9.84; p = 0.003) for Enterococcus spp. and Staphylococcus spp., respectively. Model-based odds ratios for PVC risk reduction in 2-day intervals of preop-AT ranged from 0.64 (95% CI: 0.61 to 0.68) at day 7 to 0.74 (95% CI: 0.70 to 0.78) at day 13 and 0.98 (95% CI: 0.93 to 1.02) at day 21.
Conclusions In IE cases treated with valve surgery, Staphylococcus aureus and Enterococcus spp. were associated with valve culture growth. After 7 days of antibiotic treatment, the additional effect of preop-AT on valve culture results per 2-day interval was minor. Antibiotic treatment beyond 21 days had no influence on culture results.
↵∗ Drs. Englberger and Sendi contributed equally to this work and are co-senior authors.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received October 2, 2019.
- Revision received March 30, 2020.
- Accepted April 28, 2020.
- 2020 American College of Cardiology Foundation
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