Blood culture-negative infective endocarditis: are we looking hard enough?

INTRODUCTION: Infective endocarditis is a common cardiac condition, with significant mortality. Blood culture-negative endocarditis is an important subgroup of endocarditis that holds significant morbidity and mortality. METHOD: We performed an updated review of the literature. We searched the databases of Web of Science, MEDLINE, EMBAS and Scopus for the latest clinical guidelines and literature on blood culture negative endocarditis to provide a narrative synthesis of the literature. RESULTS: There is significant heterogeneity in causes and complications of culture-negative infective endocarditis, due to an insensitivity in available clinical diagnostic pathways. Despite significant advances in diagnostic tools, the diagnostic criterion for infective endocarditis (the modified Duke’s criterion) remains insensitive to the detection of culture-negative infective endocarditis. CONCLUSION: The natural history of BCNE and our diagnostic resources are changing. It is time our criterion did too. Remembering, BCNE holds significant morbidity and mortality—the absence of organism of culture should not reassure, rather concern clinicians. Every effort should be made to accurately identify organisms.