Key result
Pre-operative antibiotics linked to ~36% lower risk of positive valve cultures per 2-day interval.
Why the study?
Bacterial growth in resected heart valve cultures is influenced by pre-operative antibiotic treatment, but the time dependency of valve culture results on treatment duration required evaluation.
Does the duration of pre-operative antibiotic treatment reduce positive valve culture results in adult patients with infective endocarditis undergoing valve surgery?
Observational (n=231)
No
Does the duration of pre-operative antibiotic treatment reduce positive valve culture results in adult patients with infective endocarditis undergoing valve surgery?
Odds Ratio: 0.64 (95% CI 0.61–0.68)
The effect of pre-operative antibiotic treatment on reducing positive valve cultures in infective endocarditis diminishes after 7 days and has no influence beyond 21 days.
Diminishing culture benefit after 7 days of pre-op antibiotics in IE; leaves open optimal duration for prospective trials.
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.
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Gisler et al. (2020) conducted an observational in Infective endocarditis (n=231). Pre-operative antibiotic treatment duration vs. Shorter duration of antibiotic treatment was evaluated on Positive valve culture results (OR 0.64, 95% CI 0.61-0.68). Pre-operative antibiotic treatment reduced the risk of positive valve cultures (OR 0.64; 95% CI 0.61-0.68 per 2-day interval at day 7), with no influence on culture results beyond 21 days.
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