Approach to investigating Blood Culture-Negative Endocarditis (BCNE)

Infective endocarditis (IE) is a globally prevalent condition associated with high morbidity and mortality (1,2). Although historically rare, the annual estimated incidence has increased to 13.8 cases per 100 000 patients, attributable to an increased incidence of degenerative valve disease, intravenous drug use and healthcare-associated invasive procedures (1-3). Despite being uncommon, the diagnosis and management require extensive investigations, and treatment is prolonged, requiring more than one antibiotic targeting the cultured organism. When routine blood cultures fail to isolate the causative organism, known as “Blood Culture-Negative Endocarditis (BCNE)”, diagnosis and treatment become particularly challenging, often leading to poorer outcomes (2-4).