CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 82 AFRICA Clinical features and outcomes of infective endocarditis: a single-centre experience Hoda Abdelgawad, Sahar Azab, Mohamed Ayman Abdel-Hay, Abdallah Almaghraby Abstract Background: Infective endocarditis (IE) may present with a broad spectrum of symptoms and signs and several tools can be used for diagnosis. Many protocols can be used for in-hospital and out-patient management. The aim of this study was to assess the clinical features, tools used and outcomes of patients diagnosed with IE in one of the tertiarycare university hospitals. Methods: This study included 90 consecutive patients admitted to the Cardiology Department in a tertiary-care university hospital in Egypt with a diagnosis of IE. Results: The mean age of the studied population was 36.72 years and 76.67% were males. The most common underlying condition was valvular heart disease (48.89%), followed by intravenous drug use (26.67%) and the most common risk factor was smoking (48.89%). The most common clinical presentation was fever (69.67%), followed by dyspnoea (55.56%), and the mean duration from symptom onset until admission was 13.28 ± 9.29 days. Positive cultures were encountered in 45.56% of patients. Surgery was indicated in 91.11% of the patients but it was performed in only 28.89%. Almost a third of patients (34.44%) died in the hospital. After one year of follow up, a further 8.47% of the patients had died, 11.86% had heart failure and 6.78% had undergone a re-do surgery. Conclusions: Nowadays IE tends to affect a younger group of patients and valvular heart disease is the main underlying condition. The mortality rate due to IE is high in developing countries and IE does not have only immediate and shortterm complications, its effects extend to a longer period of time. Keywords: infective endocarditis, valvular heart disease, echocardiography Submitted 22/1/22, accepted 28/5/22 Published online 3/8/22 Cardiovasc J Afr 2023; 34: 82–88 www.cvja.co.za DOI: 10.5830/CVJA-2022-027 The global burden of infective endocarditis (IE) is unknown because much of the world’s population lives in developing countries where people do not have proper access to advanced medical care facilities and there is usually no disease-reporting system. The overall clinical burden of IE is therefore biased and it is mainly reported by the large teaching hospitals in countries where patients have access to medical care and a good reporting system is available.1 Epidemiological studies of IE are few in number and limited in geographic coverage of populations. The incidence reported by studies from Europe and the Unites States has been stable for many years, at less than 10 cases per 100 000 person-years.2,3 The most predominant organisms reported in the literature to cause IE are gram-positive cocci, which include streptococci, staphylococci and enterococci. Due to this predominance, Duke’s criteria list these organisms by name as typical micro-organisms that are designated as one of the major criteria of positive blood cultures. However, any micro-organism can cause IE and this is evident in the many case reports and case series where rare types of bacteria are reported to be the cause of IE.4-10 IE may present with a broad spectrum of symptoms that are affected by many factors. Some of these factors include the virulence of the organism, the persistence of bacteraemia, the extent of local tissue destruction and whether there is any septic embolisation to any organ in the systemic arterial circulation or to the lungs, and the consequences of circulating immune complexes and systemic inflammatory responses.11 Many imaging modalities can be used to help in the diagnosis of IE but echocardiography always plays a crucial role, either transthoracic (TTE) or transoesophageal echocardiography (TEE). In general, TTE is readily available, needs less-experienced operators, is less invasive and is better in diagnosing right-sided infections, while TEE needs more-experienced operators, is relatively invasive and time consuming but is better in diagnosing suspected lesions and left-sided infections as well as prosthetic valve endocarditis.12-15 Treatment of IE entails two main types, medical and surgical treatment. Medical treatment consists of the usual medical care of the overall state of infection and antimicrobial therapy, which targets the pathogen causing the infection.10,16 The prevalence of culture-negative endocarditis is increasing daily and makes the management of IE more difficult.10,17 The main goal of this study was to assess the clinical and echocardiographic profiles and outcomes of patients diagnosed with IE in one of the tertiary-care university hospitals. This study was an observational and non-interventional single-centre study. The primary end-point was to evaluate in-hospital and one-year mortality rates, while the secondary end-points were one-year morbidity (hospitalisations, need for surgery, relapses), clinical and therapeutic characteristics, number and timing of imaging techniques performed, and real-life implementation of the current European Society of Cardiology (ESC) guidelines. Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt Hoda Abdelgawad, MD Sahar Azab, PhD Mohamed Ayman Abdel-Hay, PhD Abdallah Almaghraby, MSc, abdallah.aly@alexmed.edu.eg
RkJQdWJsaXNoZXIy NDIzNzc=