Infective endocarditis blood cultures

Some authors recommend contralateral reimplantation as early as 36 h after extraction in patients with local symptoms only of device-related infection [10]. In some instances, it is considered safe to perform a contralateral same-day reimplantation [11]. The reasons for a same-day reimplantation are usually pacemaker (PM) dependency or hemodynamic need for CRT in case of biventricular pacing. In fact, the risk of subsequent CIED infections and venous thrombosis increases while maintaining a transvenous temporary device, and for this reason, it cannot be used indefinitely [12]. Same-day reimplantation is considered safe if the patient is clinically proven not to have active systemic bacteremia or infection by blood culture at the time of extraction and there is a lack of transesophageal echocardiographic evidence for endocarditis and the presence of a normal white blood cell count. 

This patient was treated empirically with vancomycin alone because his physicians suspected that he had endocarditis, caused by Streptococcus of the viridans group. The history indicated that the origin of the infection was the patient s mouth. Three days later the results from the clinical microbiology laboratory showed that three blood cultures, taken at the time of admission, grew Enterococcus faecalis. susceptible to ampicillin, vancomycin, gentamicin, and streptomycin. 

Fever, cardiac murmur and vegetations are not invariably present in patients with infective endocarditis, and blood cultures are indicated in unexplained stroke particularly if there is raised erythrocyte sedimentation rate, mild anemia, neutrophil leukocytosis or a history of intravenous drug abuse. The cerebrospinal fluid (CSF) can be normal, but > 100 X 10 cells/l polymorphs is said to suggest endocarditis, although similar counts have been described in intracerebral hemorrhage and in hemorrhagic transformation of an infarct, but not in ischemic stroke (Powers 1986). 

Bacterial endocarditis. An aminoglycoside, usually gentamicin, should comprise part of the antimicrobial combination for enterococcal, streptococcal or staphylococcal infection of the heart valves, and for the therapy of clinical endocarditis which fails to yield a positive blood culture. 

Blood cultures usually should be performed in the acutely ill febrile patient. Blood culture collection should coincide with sharp elevations in temperature, suggesting the possibility of microorganisms or microbial antigens in the bloodstream. Ideally, blood should be obtained from peripheral sites as two sets (one set consists of an aerobic bottle and one set an anaerobic bottle) from two different sites approximately 1 hour apart. In selected infections, bacteremia is qualitatively continuous (e.g., endocarditis), so cultures may be obtained at any time. ... 

Culture negative endocarditis—Describes a patient in whom a clinical diagnosis of infective endocarditis is likely, but blood cultures do not yield a pathogen. 

Albrich WC, Kraft C, Fisk T, et al. A mechanic with a bad valve Blood-culture-negative endocarditis. Lancet Infect Dis. 2004 4 777-784. 

When there is neither growth in blood/tip cultures nor previously documented infection, we administer an empiric combination of different antibiotical class against the most common pathogenic agents (e.g. Moxifloxacin and Rifampicin) based on the usual antibiotic sensitivity in positive tip cultures. Blood tests are repeated at 1, 2, and 4 weeks, including inflammatory response indicators. Follow-up is necessary to document recovery from the infection and particularly regression of endocarditis lesions. 

Apart from this modest, localized form, a generalized skin condition is observed in rare cases, as well as systemic forms with endocarditis. Differential diagnosis must be made with erysipelas, a febrile streptococcal infection with a rapid extension. The disease does not leave any immunity and re-infection is therefore possible. The bacteria responsible can be cultured from bioptic cells obtained from the margins of the lesion or from the blood in systemic forms. The disease can be treated with penicillin or tetracycline for 1 week. 

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