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.
