https://doi.org/10.4081/monaldi.2022.2212

Etiology, clinical characteristics, and outcome of infective endocarditis: 10-year experience from a tertiary care center in Pakistan

By BruceBlaus - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=57340203
Vol. 92 No. 4 (2022)
Submitted: January 22, 2022
Accepted: March 10, 2022
Published: March 28, 2022
infective endocarditis, prosthetic valves, infections, cardiology
Abstract Views: 2054
PDF: 467
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Authors

Sara Salim Ali
Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States.
Imran Ahmed Qureshi
Medical College, Aga Khan University, Karachi, Pakistan.
Ahmed Ayaz
Medical College, Aga Khan University, Karachi, Pakistan.
Ainan Arshad
ainan_arshad@hotmail.com
Department of Internal Medicine, Aga Khan University, Karachi, Pakistan.
Awais Farhad
Department of Cardiology, Aga Khan University, Karachi, Pakistan.
Bushra Jamil
Department of Infectious Diseases, Aga Khan University, Karachi, Pakistan.
Muhammad Rizwan Sohail
Department of Infectious Diseases, Baylor College of Medicine, Houston, TX, United States.

This study was conducted to assess the clinical characteristics, causative agents, complications, and outcomes of infective endocarditis (IE) among patients presenting to our tertiary care center over the last decade. This retrospective cohort study included all adult patients admitted to the Aga Khan University Hospital with the diagnosis of IE over a ten-year period from 2010 to 2020.  Outcomes variables included complications during hospitalization, surgical intervention, mortality, and length of stay. We identified a total of 305 cases out of which 176 (58%) were males and 129 (42%) were females. The mean age of the patients was 46.9±18.8 years. 95 (31%) had prosthetic valves in place. Staphylococcus aureus was isolated in 54 (39%) patients followed by coagulase-negative Staphylococcus in 23 (17%). Echocardiography revealed vegetations and abscesses in 236 (77%) and 4 (1%) patients, respectively. The most common valvular complication was mitral valve regurgitation found in 26 (9%) patients, followed by tricuspid valve regurgitation in 13 (4%) patients and aortic valve regurgitation in 11 (3%) patients. Furthermore, 81 (27%) patients suffered from heart failure and 66 (22%) from a stroke during hospitalization. The mean hospital length of stay was 10.4 ± 10.6 days. 64 (21%) patients required surgical repair and the overall mortality rate was 25%. Prosthetic valve endocarditis (OR = 3.74, 95% CI = 2.15-6.50, p<0.001), chronic kidney disease (OR = 2.51, 95% CI = 1.15-5.47, p=0.036), previous stroke (OR = 2.42, 95% CI = 1.18-4.96, p=0.026), and ischemic heart disease (OR = 3.04, 95% CI = 1.50-6.16, p=0.003) were significantly associated with an increased risk of mortality. In conclusion, our study provided valuable data on the clinical characteristics and outcomes of patients with IE in a developing country. S. aureus was the most common causative agent. Heart failure and stroke were the most common complications. The presence of prosthetic valves, history of chronic kidney disease, ischemic heart disease and previous stroke were associated with a significantly increased risk of mortality. Surgical management was not associated with improved outcomes.

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
Hill EE, Herijgers P, Herregods MC, Peetermans WE. Evolving trends in infective endocarditis. Clin Microbiol Infect 2006;12:5-12. DOI: https://doi.org/10.1111/j.1469-0691.2005.01289.x
Wang A. The changing epidemiology of infective endocarditis. J Am Coll Cardiol 2012;59:1977-8. DOI: https://doi.org/10.1016/j.jacc.2012.02.030
Blumenthal J, Wolfson PM, Haspel L, Dunlap S. Infective endocarditis – current review. J Am Osteopath Assoc 1977;76:576–84.
Nunley DL, Perlman PE. Endocarditis – changing trends in epidemiology, clinical and microbiologic spectrum. Postgrad Med 1993;93:235–47. DOI: https://doi.org/10.1080/00325481.1993.11701672
Slipczuk L, Codolosa JN, Davila CD, et al. Infective endocarditis epidemiology over five decades A systematic review. PLoS One 2013;8:e82665. DOI: https://doi.org/10.1371/journal.pone.0082665
Fluit AC, Jones ME, Schmitz FJ, et al. Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from the SENTRY antimicrobial surveillance program, 1997 and 1998. Clin Infect Dis 2000;30:454460. DOI: https://doi.org/10.1086/313710
Fefer P, Raveh D, Rudensky B, et al. Changing epidemiology of infective endocarditis. a retrospective survey of 108 cases, 1990–99. Eur J Clin Microbiol Infect Dis 2002;21:432–7. DOI: https://doi.org/10.1007/s10096-002-0740-2
Moreillon P, Que YA. Infective endocarditis. Lancet 2004;363:139–49. DOI: https://doi.org/10.1016/S0140-6736(03)15266-X
Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143:e35-e71. DOI: https://doi.org/10.1161/CIR.0000000000000923
Shahid U, Sharif H, Farooqi J, et al. Microbiological and clinical profile of infective endocarditis patients: an observational study experience from tertiary care center Karachi Pakistan. J Cardiothorac Surg 2018;13:94. DOI: https://doi.org/10.1186/s13019-018-0781-y
Tariq M, Alam M, Munir G, et al. Infective endocarditis: a five-year experience at a tertiary care hospital in Pakistan. Int J Infect Dis 2004;8:163–70. DOI: https://doi.org/10.1016/j.ijid.2004.02.001
Li L, Wang H, Wang L, et al. Changing profile of infective endocarditis: A clinicopathologic study of 220 patients in a single medical center from 1998 through 2009. Tex Heart Inst J 2014;41:491–8. DOI: https://doi.org/10.14503/THIJ-13-3468
Rizk HH, Elamragy AA, Youssef GS, et al. Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility. Egypt Heart J 2019;71:17. DOI: https://doi.org/10.1186/s43044-019-0018-y
Tirumala Naresh A, Rajasekhar D, Vanajakshamma V, et al. Clinical profile and outcome of infective endocarditis in a tertiary care centre: Retrospective study. J Cardiol Cardiovasc Ther 2017;5:555659. DOI: https://doi.org/10.19080/JOCCT.2017.05.555659
Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: The international collaboration on endocarditis–Prospective cohort study. Arch Intern Med 2009;169:463–73. DOI: https://doi.org/10.1001/archinternmed.2008.603
Choudhury R, Grover A, Varma J, et al. Active infective endocarditis observed in an Indian hospital 1981-1991. Am J Cardiol 1992;70:1453-8. DOI: https://doi.org/10.1016/0002-9149(92)90299-E
Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications. Circulation 2015;132:1435–86. DOI: https://doi.org/10.1161/CIR.0000000000000296
Habib G. Management of infective endocarditis. Heart 2006;92:124–30. DOI: https://doi.org/10.1136/hrt.2005.063719
Holland TL, Baddour LM, Bayer AS, et al. Infective endocarditis. Nat Rev Dis Primer. 2016;2:16059. DOI: https://doi.org/10.1038/nrdp.2016.59
Khan NU, Farman MT, Sial JA, et al. Changing trends of infective endocarditis. J Pak Med Assoc 2010;60:4.
Arshad S, Awan S, Bokhari SS, Tariq M. Clinical predictors of mortality in hospitalized patients with infective endocarditis at a tertiary care center in Pakistan. J Pak Med Assoc 2015;65:6.
Fowler VG, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: A consequence of medical progress. JAMA 2005;293:3012-21. DOI: https://doi.org/10.1001/jama.293.24.3012
Benito N, Miro JM, De Lazzari E, et al. Health care-associated native valve endocarditis: Importance of non-nosocomial acquisition. Ann Intern Med 2009;150:586-94. DOI: https://doi.org/10.7326/0003-4819-150-9-200905050-00004
Friedman ND, Kaye KS, Stout JE, et al. Health care-associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002;137:791-7. DOI: https://doi.org/10.7326/0003-4819-137-10-200211190-00007
Vilacosta I, Olmos Blanco C, Sarriá Cepeda C, et al. Prognosis in infective endocarditis. In: Habib G, editor. Infective endocarditis: Epidemiology, diagnosis, imaging, therapy, and prevention. Cham: Springer; 2016. p. 89–103. DOI: https://doi.org/10.1007/978-3-319-32432-6_8
Mocchegiani R, Nataloni M. Complications of infective endocarditis. Cardiovasc Hematol Disord Drug Targets 2009;9:240–8. DOI: https://doi.org/10.2174/1871529X10909040240
Hasbun R, Vikram HR, Barakat LA, et al. Complicated left-sided native valve endocarditis in adults. JAMA 2003;289:1933. DOI: https://doi.org/10.1001/jama.289.15.1933
Osler W. The Gulstonian lectures, on malignant endocarditis. Br Med J 1885;1:577. DOI: https://doi.org/10.1136/bmj.1.1264.577
Cahill TJ, Prendergast BD. Infective endocarditis. Lancet 2016;387:882–93. DOI: https://doi.org/10.1016/S0140-6736(15)00067-7
Almeida NEC, Gurram P, Esquer Garrigos Z, et al. Diagnostic imaging in infective endocarditis: a contemporary perspective. Expert Rev Anti Infect Ther 2020;18:911-25. DOI: https://doi.org/10.1080/14787210.2020.1773260
Muhammad Rizwan Sohail, Department of Infectious Diseases, Baylor College of Medicine, Houston, TX

Dr. Sohail is a Professor of Medicine at Baylor College of Medicine. He graduated from The Aga Khan University in Pakistan and then pursued Internal Medicine residency at University of Illinois at Chicago-Michael Reese Medical Center, followed by Infectious Diseases fellowship at Mayo Clinic. His research interest is in cardiovascular infections, including cardiovascular implantable electronic device infections, infective endocarditis, ventricular assist device infections, and vascular graft infections. He has published over 180 original peer-reviewed articles in major medical journals. These papers address important clinical questions related to epidemiology, risk factors, clinical presentation, diagnosis, management, complications, outcomes and cost associated with cardiovascular infections. In addition, he has authored 29 book chapters on endocarditis and device infections.

Being an expert in the field of cardiovascular infections, Dr Sohail has been an invited speaker at the meetings of the Heart Rhythm Society, the American Heart Association, the Infectious Diseases Society of America, European Congress of Clinical Microbiology and Infectious Diseases, and the European Society of Cardiology, among others. In addition, he is a Visiting Professor at The Aga Khan University in Karachi, Pakistan.

He is currently a member of the Council of Clinical Cardiology, Council on Quality of Care and Outcomes Research, and Rheumatic Fever, Endocarditis and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young for the American Heart Association.

How to Cite

Ali, Sara Salim, Imran Ahmed Qureshi, Ahmed Ayaz, Ainan Arshad, Awais Farhad, Bushra Jamil, and Muhammad Rizwan Sohail. 2022. “Etiology, Clinical Characteristics, and Outcome of Infective Endocarditis: 10-Year Experience from a Tertiary Care Center in Pakistan”. Monaldi Archives for Chest Disease 92 (4). https://doi.org/10.4081/monaldi.2022.2212.
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