Infective Endocarditis Its course, complications and treatment

Authors

  • Abdul Wajid Khan Faisal
  • Syed Asif Ali Punjab Institute of Cardiology, Lahore
  • Muhammad Hassan Iqbal Punjab Institute of Cardiology, Lahore
  • Waqas Latif University of Health Sciences, Lahore
  • Salman Munir Punjab Institute of Cardiology, Lahore
  • Abdul Sattar Gujranwala Medical College, Gujranwala

Keywords:

Infective endocarditis, rheumatic heart disease, complication, management.

Abstract

ABSTRACT

Background: To combat this deadly disease, we must have an adequate knowledge about the common causative organisms, the predisposing factors, complications, and outcome of the disease. Moreover does the rheumatic prophylaxis by penicillin confer protection against endocarditis by commonest organisms? Keeping these in view we planned the study in our population.

Aims and objective: To find out the common causative organisms, complications and outcome of endocarditis in our population. To find out the role of rheumatic prophylaxis in prevention of endocarditis.

Material and Methods: This observational prospective study was conducted at Punjab Institute of Cardiology, Lahore and Wazirabad Institute of Cardiology, Wazirabad between January 2019 and January 2020. Fifty patients of infective endocarditis were enrolled. Patients were followed throughout their hospital stay. Complications and outcome were recorded. Patients of adult age group  who had either vegetation and/or blood culture positive were enrolled whereas patients who were suspected for endocarditis but lack major criteria were excluded. Vegetations were detected either on transthoracic Echo or trans-esophageal Echo or both.

Results: Between January 2019 to January 2020,we studied 50 patients of infective endocarditis, 29 of them were males and 21 were females. The age of patients ranged from 14 -69 years (27.5±9.9years). Fourteen patients were culture positive and most common organism isolated was Staphylococcus aureus.  Methicillin resistant Staphylococcus (MRSA) aureus had the worst outcome. Our patients had a very high complications rate that is 72%. The most common complication was embolism (32%) to the limbs, lung and brain and acute renal dysfunction (32%). The most of the patients who required the rheumatic fever prophylaxis  were not taking prophylaxis (3 patients as opposed to 32 patients) p value < 0.001. The three patients who were  taking rheumatic prophylaxis were culture negative and not by the organisms commonly infecting the heart. The mortality was also very high, nine patients (18%) died during their course of illness within their hospital stay. But there was significant difference in complication management medically or surgically. In medically managed patients 8 died as opposed to 0 in surgically managed patients (30.8% vs 0%).

Conclusion: Infective endocarditis carries a very high mortality and complications rate. Surgically managed patients have better outcome. Patients infected with MRSA have the worst outcome. Rheumatic heart disease is the leading underlying structural cardiac problem. The patients taking rheumatic prophylaxis may have some protection against infective endocarditis at least to commonly offending microorganisms. This needs to be studied in a larger cohort.

Key words: Infective endocarditis, rheumatic heart disease, complication, management.

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Published

2021-08-05