Infective Endocarditis Its course, complications and treatment
Keywords:Infective endocarditis, rheumatic heart disease, complication, management.
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.
Cresti A, Chiavarelli M, Scalese M, Nencioni C, Valentini S, Guerrini F, D'Aiello I, Picchi A, De Sensi F, Habib G. Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study.CardiovascDiagnTher. 2017 Feb;7(1):27-35.
Alkhawam H, Sogomonian R, Zaiem F, Vyas N, El-Hunjul M, Jolly J, Al-Khazraji A, Ashraf A.Morbidity and mortality of infective endocarditis in a hospital system in New York City serving a diverse urban population.J Investig Med. 2016 Aug;64(6):1118-23.
Shahid U, Sharif H, Farooqi J, Jamil B, Khan E.Microbiological and clinical profile of infective endocarditis patients: an observational study experience from tertiary care center Karachi Pakistan.J Cardiothorac Surg. 2018 Sep 15;13(1):94.
Sadeghpour A, Maleki M, Movassaghi M, Rezvani L, Noohi F, Boudagh S, Ghadrdoost B, Bakhshandeh H, Alizadehasl A, Naderi N, Kamali M, Ghavidel AA, Peighambari MM,Kyavar M, Pasha H.Iranian Registry of Infective Endocarditis (IRIE): Time to relook at the guideline, regarding to regional differences.Int J Cardiol Heart Vasc. 2019 Nov 7;26:
Noubiap JJ, Agbor VN, Bigna JJ, Kaze AD, Nyaga UF, Mayosi BM. Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies.Sci Rep. 2019 Nov 19;9(1):17022.
Tran HM, Truong VT, Ngo TMN, Bui QPV, Nguyen HC, Le TTQ, et al. Microbiological profile and risk factors for in-hospital mortality of infective endocarditis in tertiary care hospitals of south Vietnam.PLoSOne. 2017 Dec 14;12(12):e018.
Elamragy AA, Meshaal MS, El-Kholy AA, Rizk HH Gender differences in clinical features and complications of infective endocarditis: 11-year experience of a single institute in Egypt.Egypt Heart J. 2020 Jan 21;72(1):5.
Joffre, J., Dumas, G., Aegerter, P, Dubée V, Bigé N, Preda G, Baudel JL, et al. Epidemiology of infective endocarditis in French intensive care units over the 1997–2014 period—from CUB-Réa Network. Crit Care 23, 143 (2019).
Leitman M, Dreznik Y, Tyomkin V, Fuchs T, Krakover R, Vered Z. Vegetation size in patients with infective endocarditis.Eur Heart J Cardiovasc Imaging. 2012 Apr;13(4):330-8
Sunil M, Hieu HQ, Arjan Singh RS, Ponnampalavanar S, Siew KSW, Loch A. Evolving trends in infective endocarditis in a developing country: a consequence of medical progress?. Ann Clin Microbiol Antimicrob. 2019;18(1):43.
Watt G, Lacroix A, Pachirat O, Baggett HC, Raoult D, Fournier PE, et al. Prospective comparison of infective endocarditis in Khon Kaen, Thailand and Rennes, France. Am J Trop Med Hyg. 2015 Apr;92(4):871-4.
?im?ek-Yavuz S, Akar AR, Aydo?du S, Berzeg-Deniz D, Demir H, Haz?rolan T, et al. Consensus Report on Diagnosis, Treatment and Prevention of Infective Endocarditis by Turkish Society of Cardiovascular Surgery (TSCVS), Turkish Society of Clinical Microbiology and Infectious Diseases (KLIMIK), Turkish Society of Cardiology (TSC), Turkish Society of Nuclear Medicine (TSNM), Turkish Society of Radiology (TSR), Turkish Dental Association (TDA) and Federation of Turkish Pathology Societies (TURKPATH) Cardiovascular System Study Group. Turk Gogus Kalp Damar Cerrahisi Derg. 2020 Jan 23;28(1):2-42.
Ren Z, Mo X, Chen H, Peng J. A changing profile of infective endocarditis at a tertiary hospital in China: a retrospective study from 2001 to 2018. BMC Infect Dis. 2019 Nov 8;19(1):945.
Tak T, Reed KD, Haselby RC, McCauley CS Jr, Shukla SK. An update on the epidemiology, pathogenesis and management of infective endocarditis with emphasis on Staphylococcus aureus. WMJ. 2002;101(7):24?33.
Oliveira JLR, Santos MAD, Arnoni RT, Ramos A, Togna DD, Ghorayeb SK, et al. Mortality Predictors in the Surgical Treatment of Active Infective Endocarditis. Braz J Cardiovasc Surg. 2018 Jan-Feb;33(1):32-39.
Angsutararux, T., Angkasekwinai, N. Cumulative incidence and mortality of infective endocarditis in Siriraj hospital–Thailand: a 10-year retrospective study. BMC Infect Dis 2019, 1062.