The role of early defervescence in ruling out infective endocarditis: a cohort study

Elisavet Stavropoulou; Benoit Guery; Nicoleta Ianculescu; Piergiorgio Tozzi; Matthias Kirsch; Pierre Monney; Matthaios Papadimitriou-Olivgeris

doi:10.1016/j.cmi.2023.05.019

The role of early defervescence in ruling out infective endocarditis: a cohort study

Clin Microbiol Infect. 2023 Aug;29(8):1087.e5-1087.e8. doi: 10.1016/j.cmi.2023.05.019. Epub 2023 May 23.

Authors

Elisavet Stavropoulou¹, Benoit Guery¹, Nicoleta Ianculescu², Piergiorgio Tozzi³, Matthias Kirsch³, Pierre Monney², Matthaios Papadimitriou-Olivgeris⁴

Affiliations

¹ Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
² Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁴ Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address: Matthaios.Papadimitriou-Olivgeris@chuv.ch.

PMID: 37230250
DOI: 10.1016/j.cmi.2023.05.019

Abstract

Objectives: To evaluate the role of defervescence within 4 days from antibiotic treatment initiation in ruling out infective endocarditis (IE) among patients suspected of such diagnosis.

Methods: This study was conducted at the Lausanne University Hospital, Switzerland (January 2014 to May 2022). All patients with suspected IE being febrile upon presentation were included. IE was classified according to the modified Duke criteria proposed by the 2015 European Society of Cardiology guidelines, before or after applying the criterion 'resolution of symptoms suggesting IE within 4 days of the introduction of antibiotic therapy' based solely on early defervescence.

Results: Among 1022 episodes with suspected IE, 332 (37%) had IE according to Endocarditis-Team evaluation; 248 were classified by clinical Duke criteria as definite and 84 as possible IE. The rate of defervescence within 4 days from antibiotic treatment initiation was similar (p 0.547) among episodes without (606/690; 88%) and those with IE (287/332; 86%); among episodes classified as definite and possible IE by clinical Duke criteria, 211 of 248 (85%) and 76 of 84 (90%), respectively, defervesced within 4 days from antibiotic treatment initiation. By using early defervescence as a rejection criterion, the 76 episodes with final IE diagnosis classified as possible by clinical criteria could be reclassified as rejected.

Discussion: The majority of IE episodes defervesced within 4 days from antibiotic treatment initiation; thus, early defervescence should not be used to rule out the diagnosis of IE.

Keywords: Duke criteria; Fever; Infective endocarditis; Persistent bacteraemia; Rejection criterion.

MeSH terms

Anti-Bacterial Agents / therapeutic use
Cohort Studies
Echocardiography, Transesophageal
Endocarditis* / diagnosis
Endocarditis* / drug therapy
Endocarditis, Bacterial* / diagnosis
Endocarditis, Bacterial* / drug therapy
Endocarditis, Bacterial* / microbiology
Humans

Substances

Anti-Bacterial Agents