TITLE:
Clinical Spectrum of Infective Endocarditis in a Tertiary Care Centre in Western India: A Prospective Study
AUTHORS:
Sharad R. Jain, Jayesh S. Prajapati, Manjunath A. Phasalkar, Bhavesh H. Roy, Ashwal A. Jayram, Shaurinkumar R. Shah, Tarandeep Singh, Ashok S. Thakkar
KEYWORDS:
Infective Endocarditis; Rheumatic Heart Disease; Echocardiography
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.5 No.5,
March
14,
2014
ABSTRACT: OBJECTIVES: We examined the microbiological spectrum,
clinical profile, echocardiographic features and in-hospital outcomes of
patients with definitive IE. METHODS: A total of 75 consecutive cases of
definitive infective endocarditis (IE), admitted between January 2011 and
January 2013, were included in the study. This was a prospective study
enrolling all the consecutive definitive cases of IE admitted at U. N. Mehta
Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India. Only
the patients who met the modified Duke’s definitive criteria for IE were included
in the study. We compared enrolled patients clinicoepidemiologic features and
outcomes to subjects in the west. RESULTS: The mean age was 27.46 ± 17.11 years
with a male preponderance (2.26:1). The rheumatic heart disease (41.3%) was the
commonest underlying disease followed by coronary heart disease (34.7%). The
blood culture was positive in 40% of episodes with commonest organisms being
staphylococci (16%) and streptococci (12%). Complications were cardiovascular
in 40 (53.3%) cases (congestive heart failure in 42.7%, atrioventricular block
in 6.7%), septic shock in 20 (26.7%), neurological in 23 (30.7%) (cerebrovascular
stroke in 20%, central nervous system hemorrhage in 5.3%, encephalopathy in
5.3%) and renal failure in 20 (26.7%) of cases respectively. Only 12 (16%)
patients underwent surgery for IE. The total in hospital mortality rate was 22 (29.3%).
On multivariate analysis, congestive heart failure, renal failure, neurological
abnormalities, age 20 years and septic shock were independent predictors
of mortality. CONCLUSIONS: The spectrum of infective endocarditis is different
in Indian population compared to the west and carries a
substantial morbidity and mortality. The rheumatic heart disease is still the
commonest underlying heart disease in our population. The culture positivity
rates and surgery for infective endocarditis are unacceptably low. Early
cardiac surgery may help to improve the outcomes of these patients.