922Bartonella quintana Blood Culture-Negative Endocarditis in Washington, D.C

Background. Prior studies have demonstrated Bartonella as one of the etiologies of blood culture negative endocarditis. The objective of this abstract is to describe three cases of Bartonella quintana endocarditis identified within one year in a large hospital in Washington, D.C. Methods. Descriptive, retrospective study based on a review of medical records at an 800-bed urban hospital. All patients were identified between April 2013 and December 2013. Results. All patients were men (median age 55, range 52-57), homeless, and reported a history of alcoholism. Blood cultures were negative for all patients. Echocardiography demonstrated aortic and mitral valve perforation and regurgitation in one patient, aortic valve vegetation with regurgitation in the second, mitral and aortic valve vegetation with regurgitation in the third patient. All patients had a positive Bartonella quintana serum IgG with negative IgM. PCR on DNA extracted from cardiac valves was positive for Bartonella, and DNA sequencing of PCR amplicons identified Bartonella quintana in all patients. Patients received treatment with doxycycline/rifampin or doxycycline/gentamicin. Conclusion. Although much of the existing literature regarding Bartonella endocarditis stems from Europe, our findings suggest that Bartonella endocarditis may be an under-recognized cause of culture-negative endocarditis in the U.S., and should be considered in patients with risk factors such as homelessness and alcoholism. Amplification of DNA extracted from affected cardiac valves may provide enhanced diagnostic accuracy. Disclosures. All authors: No reported disclosures.