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. 2025 Nov 6;81(4):756-765.
doi: 10.1093/cid/ciaf163.

Single- Versus Multiple-sampling Strategy for Blood Cultures in the Diagnosis of Infective Endocarditis: The Prospective Multicenter UniEndo Study

François Goehringer  1 , Marc Soudant  2 , Corentine Alauzet  3 , Christine Selton-Suty  4 , Nelly Agrinier  2 , Jean-Marc Virion  2 , Benjamin Lefevre  1 , Nejla Aissa  5 , François Alla  6 , Yvon Ruch  7 , Yohan N'Guyen  8 , Lionel Piroth  9 , Kevin Bouiller  10 , Pierre-Yves Royer  11 , Vincent Le Moing  12 , Bruno Hoen  13   14 , Xavier Duval  15   16 ; UniEndo-AEPEI Study group
Collaborators, Affiliations
Free article

Single- Versus Multiple-sampling Strategy for Blood Cultures in the Diagnosis of Infective Endocarditis: The Prospective Multicenter UniEndo Study

François Goehringer et al. Clin Infect Dis. .
Free article

Abstract

Background: Single-sampling strategy (SSS) for blood cultures (BCs) has not been evaluated in infective endocarditis (IE). We assessed the diagnostic performance of SSS versus conventional multisampling strategy (MSS) in IE diagnosis.

Methods: Patients suspected of IE were prospectively enrolled in 8 tertiary-care centers. Five BC bottle pairs were sampled from each patient. Pairs 1, 2, and 3 were sampled simultaneously, followed by 2 additional separate pairs (4 and 5) sampled more than 1 hour later. Pairs 1, 2, and 3 emulated SSS and pairs 1, 4, and 5 emulated MSS. The sensitivity and specificity of the major microbiologic criterion of the 2015 European Society of Cardiology IE diagnostic criteria, based on the SSS and MSS BC results, were calculated using the endocarditis team's diagnosis as the gold standard.

Results: An IE was diagnosed in 101 (39.4%) of the 256 patients enrolled. Sensitivity rates of SSS and MSS were 50.5% (95% CI: 40.7-60.2) and 45.5% (95% CI: 35.8-55.3), respectively (P = .063), whereas specificity rates were 94.8% (95% CI: 91.4-98.3) and 95.5% (95% CI: 92.2-98.8), respectively (P = 1). In IE patients, SSS compared to MSS accurately upgraded the diagnosis from possible to definite IE in 1 patient and downgraded it in none.

Conclusions: Using SSS to define the major microbiologic criterion was as sensitive and specific as using MSS for diagnosing IE. Using SSS instead of MSS BC results did not lead to erroneous changes in diagnostic class according to the 2015 European Society of Cardiology criteria. Consequently, SSS may be regarded as standard practice for IE diagnosis.

Keywords: blood culture; blood sampling; diagnostic strategy; infective endocarditis; prospective study.

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Conflict of interest statement

Potential conflicts of interest . V. L. M. disclosed consulting fees, payment for lecture and support for attending meeting from Pfizer laboratory, and payment for lectures from Advanz Pharma laboratory. All the other coauthors have nothing to declare. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.