CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 86 AFRICA In our study, 48.89% of patients had a history of valvular heart disease, which is almost similar to what is reported by Habib et al. (34.2%),18 Zahn et al. (36.9%),23 and El Kadi et al. (33.8%).20 The most prevalent risk factor in our study was smoking (48.89%), followed by IV drug use in 26.67%. In the study by Habib et al., the most prevalent risk factor was arterial hypertension (48.3%), followed by smoking (25.8%), and IV drug users represented only 6.9% of the studied population.18 This was not the case in the study by Acibuca et al., who reported that smoking was a risk factor in only 7.9% of the studied population and IV drug users represented only 0.7%.21 In our study, the mean duration from the first symptom to admission was 13.28 ± 9.29 days, with a range of one to 41 days. The most common symptom was fever (69.67%), followed by dyspnoea (55.56%). This is different to what was reported by Habib et al., where the median time from symptom development until admission was four days, with a range from zero to 15 days. The most frequent symptom was also fever (77.7%), followed by dyspnoea and heart failure symptoms (27.2%).18 This conflicting data may represent delayed diagnoses and late seeking for medical advice in developing countries in comparison with developed countries and the whole world. Regarding microbiological data, in our study, positive cultures were encountered in only 45.56% of patients and the most prevalent pathogen was MRSA, which was seen in 53.7% of the patients with positive cultures. This is in disagreement with most of the recently published data. Zahn et al. reported that positive cultures were seen in 100% of their population, with the most common organism being methicillin-sensitive Staphylococcus aureus (MSSA) (21.2%), and MRSA was seen in only 2.2% of cases.23 Blanchard et al. reported that 86.87% of the patients had positive blood cultures and the most commonly encountered organism was MSSA (35%), with MRSA being seen in only 3% of cases.19 Babeș et al. reported that 69.56% of the patients had a positive blood culture and the most commonly encountered organism was MRSA (23%), followed by MSSA (22%).22 El Kadi et al. reported that 91.4% of the patients had positive blood cultures and the most common organism was Staphylococcus aureus without mentioning whether it was methicillin sensitive or resistant.20 Acibuca et al. reported that 78.4% of their patients had a positive blood culture and the most commonly encountered organism was MRSA (30.2%).21 Finally, Habib et al. reported that 79% of the patients had a positive blood culture with the most common organism being MSSA (24.2%), and only 7.2% had MRSA.18 These conflicting results may show evidence of misuse of antimicrobials in developing countries, which may have led to more negative cultures and more resistant strains. In our study, all patients had 2D TTE (100%), while only 84.44% underwent a 2D TEE study. The average vegetation size was 17 ± 9 mm. The mean LVEF was 58.19 ± 8.24%. The most prevalent site of vegetations was the left heart (61.11%) and the most affected valve was the native mitral valve (35.56%). Blanchard et al. reported that the average vegetation size was 11 ± 7 mm and the most common location affected was the mitral valve (53%), followed by the aortic valve (51%).19 Babeș et al. stated that all their patients had a TTE (100%) and only 38% had a TEE. The most common site affected was the native mitral valve (35.9%), followed by the native aortic valve (31.5%).22 El Kadi et al. stated that 97.8% of their patients had at least one TTE and 81.3% had at least one TEE. The aortic valve (either native or prosthetic) was the most commonly affected location (62.6%), followed by the mitral valve (29.5%).20 In our study, most of the patients received guidelinerecommended empirical antibiotic therapy, and the most commonly prescribed drug was gentamycin (91.11%), followed by vancomycin (87.78%). The most commonly prescribed drug in the study by Blanchard et al. was also gentamycin (71%), followed by oxacillin (29%) and ceftriaxone (27%), while only 16% received vancomycin.19 In our study, persistent fever was the most encountered problem in hospitalised patients (42.22%), followed by embolic complications (32.22%), and the most common sites of embolism was cerebrovascular (8.89%) and lower limbs (8.89%). Blanchard et al. reported that peripheral embolisation was encountered in 47%, including cerebral embolism (27%).19 Babeș et al. reported in their study that the most commonly encountered problem was heart failure (48.9%). Embolic events were seen in 20.7% of the patients and the predominant site was the cerebral circulation (13%).22 El Kadi et al. reported that embolic events were seen in 16.5% of their patients and it was more consistently seen in patients with prosthetic valves.20 Acibuca et al. reported that the most encountered complication during hospitalisation was persistent fever (30.2%), and embolic events were seen in 39.6% of the included patients during the whole follow-up period.21 Habib et al. reported that embolic events were seen in 20.6% of patients and it was considered the most frequent Heart failure 32% Death 23% Re-do surgery 18% Re-infection 13% Embolic event 14% Fig. 3. Events at one-year follow up. Table 7. One-year follow-up data Follow up data (n = 59) n (%) Number 48 (81.36) Lost to follow up 11 (18.64) Re-infection 3 (5.08) Heart failure 7 (11.86) Embolic event 3 (5.08) Re-do surgery 4 (6.78) Death 5 (8.47)
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