Empirical antimicrobian treatment of the patient with infectious endocarditis. Clinical case

Abstract

Background. Infective endocarditis (IE) with negative blood cultures (BC) remains a severe pathology, with a high risk of mortality, caused by the progression of heart failure, embolic and neurological complications. Empirical antibacterial treatment of these patients has a longer duration and adverse effects. Objective(s).: Study of the evolution of infective endocarditis with negative blood cultures and clinical case presentation of a patient with infective endocarditis with empirical antibacterial treatment. Materials and methods. 38-year-old woman, with IE and negative BC, admitted to the Cardiology Department of the CMH „Holy Trinity”. Anamnesis: fever, chills for 2 months, antimicrobial treatment. Clinically and paraclinically evaluated by: ECOCG, 3 sets of blood cultures, serological tests, clinical and biochemical analyses, interdisciplinary consultation. Results. Clinical: fever 39-40°C, chills, sweating, palpitations, fatigue. Objective(s).: pallor of the skin, Janeway lesions. Rhythmic heart sounds, FCC 110 b/min, systolic murmur at the apex, BP 120/70 mmHg. Laboratory: BC from 3 cultures – negative. ECHO: 15mm vegetations on the MV, rupture of the anterior MV chord, MV regurgitation gr. III, EF 54%; Hb 92 g/l, erythrocytes: 2.9 x10^12, leukocytes: 14x10^9, ESR 48 mm/hour; RF 48 U/l; CRP 96 U/l; ALT 58 mmol/l. Abdominal USG: hepatomegaly. Combined treatment with 3 regimens of antimicrobial drugs in maximum doses, antifungals, diuretics, cardiac glycosides, surgical intervention. Conclusion(s). Patients with infective endocarditis present negative blood cultures in the event of antibacterial treatment prior to blood culture collection or specific microbial trigger, which worsens the course of the disease, requires empirical antibacterial regimens and surgical eradication of the infection.