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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 4, July/August 2021
188
AFRICA
An epidemiological study to define the recent clinical
characteristics and outcomes of infective endocarditis in
southern Turkey
Aynur Acibuca, Mustafa Yilmaz, Sefa Okar, Ebru Kursun, Onur Acilar, Abdullah Tekin, Yusuf Ziya
Demiroglu, Ibrahim Haldun Muderrisoglu
Abstract
Introduction:
The aim of this study was to characterise the
recent features of patients with infective endocarditis (IE) at
one referral centre in southern Turkey, in order to be able to
identify the high-risk subgroup and revise preventative meas-
ures and management strategies.
Methods:
Medical records of patients 18 years and older, who
had been diagnosed with IE according to the Duke criteria
between January 2009 and October 2019, were retrospectively
evaluated in a referral general hospital.
Results:
The total of 139 IE cases comprised 59.7% males and
40.3% females, with a mean age of 55 ± 16 years. The most
encountered symptom was fever (55.4%) and the mitral valve
(54%) was the most frequently involved. The most common
causative micro-organisms were coagulase-negative staphylo-
cocci (30.2%). The in-hospital mortality rate was 30.2%, with
congestive heart failure, chronic renal disease and chronic
dialysis found to be significantly associated with in-hospital
mortality.
Conclusion:
The study results demonstrate the recent epidemi-
ological features of IE in southern Turkey that are important
for clinicians to manage diagnostic and therapeutic processes
successfully. Older age, the predominance of staphylococci
and higher surgery rates are consistent with the changing
trends of IE in some parts the world.
Keywords:
infective endocarditis, epidemiology, dialysis, mortality
Submitted 10/5/20, accepted 21/3/21
Published online 7/4/21
Cardiovasc J Afr
2021;
32
: 188–192
www.cvja.co.zaDOI: 10.5830/CVJA-2021-009
Infective endocarditis (IE) is an uncommon disease with an annual
incidence of three to 10 per 100 000 people, but it remains a serious
health problem, causing lengthy hospitalisation with high costs.
1
Recently there have been some changes in the epidemiology
of IE worldwide, with
Staphylococcus aureus
and coagulase-
negative staphylococci replacing streptococci as the causative
micro-organisms.
2
When the underlying predisposing factors
were reviewed, a decrease was seen in the prevalence of rheumatic
heart disease (RHD), and an increase in prosthetic heart material,
intravenous catheters and immunosupression. IE patients tend to
be older now than they were previously.
3
The epidemiology of IE
also shows regional variation.
IE has a high mortality rate,
4
possibly because of late or
missed diagnosis. Therefore, physicians should be fully aware of
recent trends and developments for early diagnosis and optimal
management of patients with IE.
This retrospective study was conducted to define recent trends
in the epidemiology of IE over a 10-year period at a tertiary-care
centre, which is a referral hospital in southern Turkey, and to
evaluate clinical outcomes. We aim to guide clinicians in defining
the high-risk population and choosing the right empirical
antibiotic therapy.
Methods
Medical records of a referral general hospital were scanned to
identify patients diagnosed with IE between January 2009 and
October 2019. Modified Duke criteria were used to define IE,
and definite IE cases were enrolled into the study.
5
The data
of 139 IE patients, whose management was completed in our
hospital, were included in this research. Patients who were under
the age of 18 years or who left the hospital before treatment was
completed were excluded from the study.
Basal characteristics (gender, age), symptoms on admission,
echocardiographic features (structural heart disease, prosthetic
heart valve), laboratory and microbiological examinations (culture
results), co-morbidities (hypertension, chronic dialysis, diabetes
mellitus), predisposing factors (invasive procedures, intravascular
catheters), surgery and mortality outcomes were recorded.
Echocardiographic examinations were also screened to identify
the valve involved and vegetation size. Possible complications
of IE were analysed from clinical course records, and embolic
complications were determined from radiological studies.
Approval for the study was granted by the Institutional Ethics
Committee (approval code: 43867).
Statistical analysis
Data obtained in the study were analysed statistically using SPSS
forWindows version 21.0 (SPSS Inc, Chicago, IL, USA) software.
Department of Cardiology, Baskent University School
of Medicine, Dr Turgut Noyan Application and Research
Center, Adana, Turkey
Aynur Acibuca, MD,
aynuracibuca85@gmail.comMustafa Yilmaz, MD
Sefa Okar, MD
Onur Acilar, MD
Abdullah Tekin, MD
Department of Infectious Diseases and Clinical Microbiology,
Baskent University School of Medicine, Dr Turgut Noyan
Application and Research Center, Adana, Turkey
Ebru Kursun, MD
Yusuf Ziya Demiroglu, MD
Department of Cardiology, Baskent University School of
Medicine, Ankara, Turkey
Ibrahim Haldun Muderrisoglu, MD