Q: In patients with Infective Endocarditis (IE) without symptoms, antibiotics can be withheld till the results of blood cultures are available?
Answer: AIn case of IE, it is imperative that a treatment strategy is planned which may require long-term antibiotics. Also, the need for surgery needs to be established. Knowing the organism is one of the most important steps. In patients who have no symptoms, antibiotics can be deferred till the results of blood cultures are available. Even in patients with acute symptoms of IE, endeavors should be made to obtain blood cultures prior to the start of the empiric therapy.
Ideally, Blood cultures should be obtained from three (at least two) venipuncture sites spaced over 30-60 minutes.
1. Katsouli A, Massad MG. Current issues in the diagnosis and management of blood culture-negative infective and non-infective endocarditis. Ann Thorac Surg. 2013 Apr;95(4):1467-74. doi: 10.1016/j.athoracsur.2012.10.044. Epub 2013 Mar 5. PMID: 23481702.
2. Siddiqui BK, Tariq M, Jadoon A, Alam M, Murtaza G, Abid B, Sethi MJ, Atiq M, Abrar S, Smego RA Jr. Impact of prior antibiotic use in culture-negative endocarditis: review of 86 cases from southern Pakistan. Int J Infect Dis. 2009 Sep;13(5):606-12. doi: 10.1016/j.ijid.2007.10.009. Epub 2009 Jan 7. PMID: 19131263.