Clinical Profile and Short Outcome of Infective Endocarditis as A Single Center Experience
Abstract
Background: growth of microorganisms on heart valves inner lining eventually cause what is called infectiveendocarditis. The pathological core lesion of infective endocarditis is termed a vegetation, which is composed
of colonies of microorganisms, inflammatory cells, fibrin and platelets.
Aims: to clarify the clinical background, microbiological entity and in hospital course of patients with
infective endocarditis in Ibn-AL Betar cardiac Centre.
Methods: all patients with infective endocarditis admitted to Ibn-AL Betar cardiac center between June 2018
and January 2020 were studied. Echocardiography and lab tests done for all patients. Pregnant women and
pediatrics less than 14 years old were excluded from the study.
Results: our studied group was 30 patients, 30% female and 70% male with a median age of 34 years.
Infective endocarditis affecting native valves in 20 patients (66.6%), prosthetic valves in 5 patients (16.6%),
associating congenital heart disease in 4 patients (16.6%) and device related in one patient (3.3%). most
common valve to be infected was the aortic valve. Blood culture was positive in 8 patients
(26.6%).Staphylococcus aureus were the prevalent microorganism (16.6%).In hospital complications included:
heart failure in 22 patients (73.3%), septic shock in 5 patients (16.6%), acute renal failure in 4 patients
(13.3%), paravalvular abscess in 2 patients (6.6%), systemic embolization in 2 patients (6.6%) and septic
pulmonary embolization in 2 patients (6.6%). Surgery is indicated in 14 patients (46.6%); of them 5 patients
(16.6%) undergoing early surgical intervention. In hospital mortality was (16.6%).
Conclusion :Infective endocarditis is a hazardous disease. It comprises an increase in-hospital complications
with an enhanced mortality rate (16.6%). Staphylococcus aureus are the prevalent microorganism. Fever and
dyspnea are commonest presentations while peripheral stigmata of endocarditis were rarely observed in our
study.
References
D. T. Durack, A. S. Lukes, D. K. Bright et al., “New criteria for diagnosis of infective
endocarditis: utilization of specific echocardiographic findings,” The American Journal
ofMedicine, vol. 96, no. 2, pp. 200–209, 1994
Correa de Sa DD, Tleyjeh IM, Anavekar NS, et al. Epidemiological trends of infective
endocarditis: a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 2010;
:422-6. [Erratum, Mayo Clin Proc 2010; 85:772.]
Duval X, Delahaye F, Alla F, et al.Temporal trends in infective endocarditis in the context of
prophylaxis guideline modifications: three successive population-
based surveys. J Am Coll Cardiol 2012; 59:1968-76.
Fedeli U, Schievano E, Buonfrate D, Pellizzer G, Spolaore P. Increasing incidence and
mortality of infective endocarditis: a population-based study through a
record-linkage system. BMC Infect Dis 2011; 11:48.
Federspiel JJ, Stearns SC, Peppercorn AF, Chu VH, Fowler VG Jr. Increasing US rates of
endocarditis with Staphylococcus aureus: 1999-2008. Arch Intern Med 2012; 172:363-5.
Sy RW, Kritharides L. Health care exposure and age in infective endocarditis: results of a
contemporary population based profile of 1536 patients in Australia.
Eur Heart J 2010; 31:1890-7.
Murdoch DR, Corey GR, Hoen B, et al.Clinical presentation, etiology, and outcome of
infective endocarditis in the 21stcentury: the International Collaboration on EndocarditisProspective Cohort Study.
Arch Intern Med 2009; 169:463-73.
Selton-Suty C, Célard M, Le Moing V,
et al. Preeminence of Staphylococcus aureus
in infective endocarditis: a 1-yearpopulation-based survey. Clin Infect Dis 2012; 54:1230-9.
Tleyjeh IM, Abdel-Latif A, Rahbi H, et al. A systematic review of populationbased studies of
infective endocarditis. Chest 2007; 132:1025-35.
Fournier PE, Thuny F, Richet H, et al.Comprehensive diagnostic strategy for blood culturenegative endocarditis: a prospective study of 819 new cases. Clin
Infect Dis 2010; 51:131-40.
Houpikian P, Raoult D. Blood culturenegative
endocarditis in a reference center: etiologic diagnosis of 348 cases. Medicine (Baltimore) 2005;
:162-73.
Stehbens WE, Delahunt B, Zuccollo JM. The histopathology of endocardial sclerosis.
Cardiovasc Pathol 2000; 9:161-73.
Brouqui P, Raoult D. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev
; 14:177-207.
Li JS, Sexton DJ, Mick N, et al. Propose modifications to the Duke criteria for the diagnosis
of infective endocarditis. Clin Infect Dis 2000; 30:633-8.
Greub G, Lepidi H, Rovery C, et al. Diagnosis of infectious endocarditis in patients
undergoing valve surgery. Am J Med 2005; 118:230-8.
Lepidi H, Coulibaly B, Casalta JP, Raoult D. Autoimmunohistochemistry: a new method for
the histologic diagnosis of infective endocarditis. J Infect Dis
; 193:1711-7.
Botelho-Nevers E, Thuny F, Casalta JP, et al. Dramatic reduction in infective endocarditisrelated mortality with a management- based approach. Arch Intern Med 2009; 169:1290-8.
Morris AJ, Drinković D, Pottumarthy S, MacCulloch D, Kerr AR, West T. Bacteriological
outcome after valve surgery for active infective endocarditis: implications
for duration of treatment after surgery. Clin Infect Dis 2005; 41:187-94.
Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of
infective endocarditis (new version 2009): the Task Force on the
Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of
Cardiology (ESC): endorsed by the European Society of Clinical Microbiology and Infectious
Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and
Cancer. Eur Heart J 2009; 30:2369-413.
R. S. Math, G. Sharma, S. S. Kothari et al., “Prospective study of infective endocarditis from
a developing country,” TheAmerican Heart Journal, vol. 162, no. 4, pp. 633–638, 2011.
S. S. Kothari, S. Ramakrishnan, andV. K. Bahl, “Infective endocarditis—an Indian
perspective,” Indian Heart Journal, vol. 57, no. 4, pp. 289–294, 2005.
N.Garg, B. Kandpal, S. Tewari,A.Kapoor, P. Goel, andN. Sinha, “Characteristics of infective
endocarditis in a developing country- clinical profile and outcome in 192 Indian patients, 1992–
,” International Journal of Cardiology, vol. 98, no. 2, pp. 253–260, 2005.
Hill EE, Herijgers P, Claus P, et al. Infective endocarditis: changing epidemiology and
predictors of 6-month mortality: a prospective cohort study. Eur Heart J 2007; 28:196.
Al-Mogheer B, Ammar W, Bakoum S, et al. Predictors of inhospital mortality in patients
with infective endocarditis. The Egypt Heart J 2012. Article in press.
Murdoch DR, Corey GR, Hoen BL. Clinical presentation, etiology, and outcome of infective
endocarditis in the 21st century. Arch Intern Med. 2009; 169:463.
Chaudhary R. Active infective endocarditis observed in an Indian Hospital 1981-91. Am J
Cardiol. 1992; 70:1453-8.
Baddour LM, Wilson WR, Bayer AS. Infective endocarditis: Diagnosis, antimicrobial
therapy, and management of complications. A statement for healthcare professionals from the
Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on
Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and
Cardiovascular Surgery and Anesthesia, American HeartAssociation. Circulation. 2005;
:e394.
Kabde VR, Bidwai PS, Berry JN, Agarwal KC. Clinical and bacteriological studies in
infective endocarditis. Indian Heart J. 1970; 22:318-32.
Agarwal RK, Gupta R, Agarwal SC, Dwivedi M. Bacterial endocarditis-its diagnostic
problems. J Assoc Physicians India. 1981; 29:745-50.
Bayer AS, Bolger AF, Taubert KA. Diagnosis and management of infective endocarditis and
its complications. Circulation. 1998; 98:2936.
Hoen B, Alla F, Selton-Suty C, et al. Changing profile of infective endocarditis: results of a
-year survey in France. JAMA 2002; 288:75–81.
Yiu KH, Siu CW, Lee KL, Fong YT, et al. Emerging trends of community acquired infective
endocarditis. Int J Cardiol 2007; 121: 119–22.
Rivas P, Alonso J, Moya J, et al. The impact of hospital-acquired infections on the microbial
etiology and prognosis of late-onset prosthetic valve endocarditis. Chest 2005; 128:764–71.
Tariq M, Karim B. Int J Collaborative Res Intern Med Public Health 2009; 1(3):84–99.
Yousuf RM, How SH, Fauzi ARM, et al. Infective endocarditisin the east coast of peninsula
Malaysia: a two year retrospectivesurvey from Kuantan. JK-Practitioner 2006; 13(1):5–8.
Steckelberg JM, Wilson WR. Risk factors for infective endocarditis. Infect Dis Clin North
Am 1993; 7:9–19.
Klug D, Balde M, Pavin D, Hidden-Lucet F, et al. Risk factors related to infections of implanted
pacemakers and cardioverterdefibrillators: results of a large prospective study. Circulation 2007;
:1349–55.
Rehman S, Ghulam Shabbier, Shahid M. Clinical presentation of infective endocarditis. J Postgrad
Med Inst 2002; 16: 55–63.
Chen CH, Lo MC, Hwang KL, et al. Infective endocarditis with neurological complication: 10 year
experience. J Mcrobiol Immunol Infect 2001; 34:119–24.
Zamorano J, Sanz J, Almeria C, et al. Difference betweenendocarditis with true negative blood
cultures and those withprevious antibiotic treatment. J Heart valve Dis 2003; 12:256–60.
Mylonakis E, Calderwood SB. Infective endocarditis in adults. NEngl J Med 2001; 345:1318–30.
C. Rostagno, G. Rosso, F. Puggelli et al., “Active infective endocarditis:clinical characteristics and
factors related to hospitalmortality,” Cardiology Journal, vol. 17, no. 6, pp. 566–573, 2010.
J. C. Castillo, M. P. Anguita, M. Ruiz et al., “Changing epidemiologyof native valve infective
endocarditis,” Revista Espanola deCardiologia, vol. 64, no. 7, pp. 594–598, 2011.
Kini V, Logani S, Ky B. Transthoracic and transesophageal echocardiography for the indication of
suspected infective endocarditis: Vegetations, blood cultures and imaging. J Am Soc Echocardiograph.
; 23:396.
Tornos P, Iung B, Permanyer-Miralda G, et al. Infective endocarditisin Europe: lessons from the Euro
heart survey. Heart2005; 91:571–5.
Van Le, Gill S. Serious complications after infective endocarditis.Dan Med Bul 2010; 57(10).
Habib G. Management of infective endocarditis. Heart
; 92:124–30.
Nashmi A, Memish ZA. Infective endocarditis at a tertiary carecentre in Saudi Arabia: review of 47
cases over 10 years. EastMediterr Health J 2007; 13:64–71.
Erbay AR, Erbay A, Canga A, et al. Risk factors for in-hospitalmortality in infective endocarditis: five
years’ experience at a tertiary care hospital in Turkey. J Heart Valve Dis 2010; 19(2):216.
Ruotsalainen E, Sammalkorpi K, et al. Clinical manifestationsand outcome in Staphylococcus aureus
endocarditis amonginjection drug users and non addicts: a prospective study of 74patients. BMC Infect
Dis 2006; 6:137.
Miyake M, Hatta K, Kameyama T, et al. Infective endocarditisdeveloping as uremia. Intem Med
; 44:598–6
Downloads
Published
Issue
Section
License
Copyright (c) 2024 University of Thi-Qar Journal Of Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
