Key result
Culture-negative infective endocarditis shows comparable long-term survival to culture-positive cases after surgery.
Why the study?
Culture-negative infective endocarditis presents diagnostic and therapeutic challenges with potentially worse clinical outcomes compared to culture-positive infective endocarditis.
Does surgical outcome and long-term prognosis differ between culture-negative and culture-positive infective endocarditis?
Cohort (n=698)
No
Does surgical outcome and long-term prognosis differ between culture-negative and culture-positive infective endocarditis?
Hazard Ratio: 1.21 (95% CI 0.72–2.03)
Absolute Event Rate: 86% vs 89%
p-value: p=0.47
Surgically treated culture-negative infective endocarditis has comparable overall long-term survival to culture-positive endocarditis, despite patients presenting with worse preoperative renal and cardiac function, though female patients with CNIE carry a significantly worse prognosis.
Supports equivalent post-surgical survival in culture-negative IE; leaves open female-specific risks for prospective validation.
Background Culture-negative infective endocarditis (CNIE) presents significant diagnostic and therapeutic challenges due to the absence of identifiable pathogens, leading to empirical antibiotic treatment and potentially worse clinical outcomes. This study aims to compare the clinical characteristics, surgical outcomes, and long-term prognosis of CNIE and culture-positive infective endocarditis (CPIE) patients. Methods A total of 698 patients who underwent surgery for infective endocarditis (IE) were included, with 154 (22.1%) classified as CNIE and 544 (77.9%) as CPIE. Baseline characteristics, preoperative risk factors, intraoperative variables, and postoperative outcomes were analyzed. Results CNIE patients exhibited significantly worse preoperative cardiac and renal function. Multivariate analysis identified female, perivalvular abscess and renal insufficiency are independent risk factors for early mortality in IE patients. Postoperatively, CNIE patients had a higher incidence of continuous renal replacement therapy (18% vs. 9%, p<0.01). Although long-term follow-up data showed no significant difference in the overall prognosis between CNIE and CPIE patients, subgroup analysis found that female CNIE patients showed worse long-term prognosis (HR=2.46 [1.16-5.23]; P=0.02). Conclusions Although the survival rates of CNIE and CPIE are similar, the prognosis of female CNIE patients is significantly worse. Clinical Perspective Culture-negative infective endocarditis (CNIE) patients who undergo surgery have favorable long-term outcomes comparable to culture-positive infective endocarditis (CPIE) patients, emphasizing the pivotal role of surgical intervention in infective endocarditis treatment. Female CNIE patients exhibit significantly worse surgical prognosis, highlighting the need for increased clinical attention and efforts to identify pathogens using other methods like tissue culture, PCR and mNGS. Although overall prognosis is similar, CNIE may indirectly worsen outcomes by impairing renal function, underscoring the importance of postoperative eGFR monitoring and protect kidney function.
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Zhang et al. (2025) conducted a cohort in Infective endocarditis (n=698). Culture-negative infective endocarditis (CNIE) vs. Culture-positive infective endocarditis (CPIE) was evaluated on Long-term cumulative survival/mortality (HR 1.21, 95% CI 0.72-2.03, p=0.47). Culture-negative infective endocarditis had comparable overall long-term survival to culture-positive infective endocarditis in surgical patients (HR 1.21), although females had worse outcomes.
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