Cardiovascular Journal of Africa: Vol 32 No 4 (JULY/AUGUST 2021)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 4, July/August 2021 AFRICA 191
The mortality rate of IE has been reported to vary between 14
and 37% in various studies, and in Turkey, from 15.3 to 33%.6,9,26
The mortality rate in our study of 30.2% was higher than the
most recently reported rate from Turkey of 27.8%.9 This may
have been due to the high number of dialysis patients and those
with prosthetic heart material, and the referral of severely ill
patients or those with more complications. However, it is striking
that the mortality rate of IE has not decreased over the years.
Consistent with previous reports, this study showed that
end-stage renal disease and heart failure were associated with
increased risk of death.9,14 This indicates the high-risk population.
A strength of this research, compared with previous reports
from Turkey, is the high number of dialysis patients in the
study population. They comprised 23.7% of the series, with a
mortality rate of 48.5%. The most encountered micro-organisms
in these patients were coagulase-negative staphylococci (39.4%).
Our results are also consistent with those of a previous study
performed on 52 dialysis patients with IE, which reported a 37%
in-hospital mortality rate and a prevalence of 87% gram-positive
micro-organisms in the aetiology.27
Mostaghim et al. reported on a study population of IE that
included 26.7% dialysis patients, and the most frequently detected
micro-organisms were coagulase-negative staphylococci.26
Consistent with the current study results, Leblebicioglu et al.
reported that haemodialysis was a risk factor for mortality.11
The above data demonstrate that attention must be paid and
strategies must be developed to prevent healthcare-related
bacteraemia in order to reduce the seriously poor outcomes in
dialysis patients. In addition, an arteriovenous fistula should be
preferred over vascular catheters.
This study had several limitations, primarily the retrospective
design. Previous antibiotic use could not be identified completely,
and some statistical analyses according to risk factor and
causative organism could not be performed because of the low
number of patients. Furthermore, as the study was conducted in
a referral centre, there may have been a selection bias towards
severely ill patients or those with more complications.
Conclusion
The results of this study are of value for helping in the revision
of preventative, diagnostic and management strategies for IE.
The important aspects of IE epidemiology in southern Turkey
were older age, increased prevalence of staphylococci and high
mortality rates. TEE was found to be better than TTE for the
diagnosis of IE, even in patients without prosthetic heart valves,
and should be performed in all patients with suspected IE.
References
1. Cahill TJ, Prendergast BD. Infective endocarditis. Lancet 2016;
387(10021): 882–893.
2. Selton-Suty C, Célard M, Le Moing V, Doco-Lecompte T, Chirouze C,
Iung B, et al. Preeminence of Staphylococcus aureus in infective endo-
carditis: a 1-year population-based survey. Clin Infect Dis 2012; 54(9):
1230–1239.
3. Correa de Sa DD, Tleyjeh IM, Anavekar NS, Schultz JC, Thomas
JM, Lahr BD, et al . Epidemiological trends of infective endocarditis: a
population-based study in Olmsted County, Minnesota. Mayo Clin Proc
2010; 85(5): 422–426.
4. Jordal S, Kittang BR, Salminen PR, Eide GE, Kommedal E, Wendelbo
E, et al. Infective endocarditis in Western Norway: a 20-year retrospec-
tive survey. Infect Dis (Lond) 2018; 50(10):757–763.
5. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP,
Del Zotti F, et al. 2015 ESC guidelines for the management of infec-
tive endocarditis: the Task Force for the Management of Infective
Endocarditis of the European Society of Cardiology (ESC). Endorsed
by: European Association for Cardio-Thoracic Surgery (EACTS), the
European Association of Nuclear Medicine (EANM). Eur Heart J 2015;
36(44): 3075–3128.
6. Sucu M, Davuto ğlu V, Ozer O, Aksoy M. Epidemiological, clinical and
microbiological profile of infective endocarditis in a tertiary hospital in
the South-East Anatolia Region. Turk Kardiyol Dern Ars 2010; 38(2):
107–111.
7. Elbey MA, Akda ğ S, Kalkan ME, Kaya MG, Sayın MR, Karapınar
H, et al. A multicenter study on experience of 13 tertiary hospitals in
Turkey in patients with infective endocarditis. Anatol J Cardiol 2013;
13(6): 523–527.
8. Tuğcu A, Yildirimtürk O, Baytaroğlu C, Kurtoğlu H, Köse O, Sener M,
et al. Clinical spectrum, presentation, and risk factors for mortality in
infective endocarditis: a review of 68 cases at a tertiary care center in
Turkey. Turk Kardiyol Dern Ars 2009; 37(1): 9–18.
9. Şimşek-Yavuz S, Şensoy A, Kaşıkçıoğlu H, Çeken S, Deniz D, Yavuz A,
et al. Infective endocarditis in Turkey: aetiology, clinical features, and
analysis of risk factors for mortality in 325 cases. Int J Infect Dis 2015;
30: 106–114.
10. Poesen K, Pottel H, Colaert J, De Niel C. Epidemiology of infective
endocarditis in a large Belgian non-referral hospital. Acta Clin Belg
2014; 69(3): 183–190.
11. Leblebicioglu H, Yilmaz H, Tasova Y, Alp E, Saba R, Caylan R, et al .
Characteristics and analysis of risk factors for mortality in infective
endocarditis. Eur J Epidemiol 2006; 21(1): 25–31.
12. Habib G, Erba PA, Iung B, Donal E, Cosyns B, Laroche C, et al .
Clinical presentation, aetiology and outcome of infective endocarditis.
Results of the ESC-EORP EURO-ENDO (European infective endo-
carditis) registry: a prospective cohort study. Eur Heart J 2019; 40(39):
3222–3232.
13. Li L, Wang H, Wang L, Pu J, Zhao H. 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(5): 491–498.
14. Angsutararux T, Angkasekwinai N. Cumulative incidence and mortality
of infective endocarditis in Siriraj hospital – Thailand: a 10-year retro-
spective study. BMC Infect Dis 2019; 19(1): 1062.
15. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd,
Fleisher LA, et al. AHA/ACC focused update of the 2017 AHA/ACC
guideline for the management of patients with valvular heart disease:
a report of the American College of Cardiology/American Heart
Association Task Force on Clinical Practice Guidelines. J Am Coll
Cardiol 2017; 70(2): 252–289.
16. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL,Galderisi
M, et al. Recommendations for the practice of echocardiography in
infective endocarditis. Eur J Echocardiogr 2010; 11(2): 202–219.
17. Demirbağ R, Sade LE, Aydın M, Bozkurt A, Acartürk E. The Turkish
registry of heart valve disease. Turk Kardiyol Dern Ars2013; 41(1): 1–10.
18. Dzupova O, Machala L, Baloun R, Maly M, Benes J, et al. Incidence,
predisposing factors, and aetiology of infective endocarditis in the
Czech Republic. Scand J Infect Dis 2012; 44(4): 250–255.
19. Thuny F, Grisoli D, Collart F, Habib G, Raoult D. Management
of infective endocarditis: challenges and perspectives. Lancet 2012;
379(9819): 965–975.