Epidomiological characteristics of infective endocarditis

##plugins.themes.academic_pro.article.sidebar##

Published Apr 2, 2014
Download
pdf
Vol. 92 No. 2 (2014): Issue Feb 2014

##plugins.themes.academic_pro.article.main##

R. Lakhdhar
C. Chourabi
M. Drissa
M. Cheour
H. Drissa

Abstract

Background: Infective endocarditis (IE) is a serious pathology which is in a continuum evolution in the setting of diagnosis and therapeutic fields
aim : To describe clinical, echocardiographic, microbiological, therapeutic and outcome characteristics of infective endocarditis in a Tunisian population.
methods: The records of 135 patients admitted to adult cardiology department of la Rabta hospital between January 1981and December 2011 were collected. The diagnosis of certain IE was retained according to modified Duke Criteria.
results: The mean age of patients was 38.5 ± 16 years, with a male predominance (sex ratio: 1.4). IE affected native valves in 77% of cases, prosthetic valve in 15.5% of cases, congenital heart disease in 2% and pacemaker in 1.48% of patients. The portal of entry was identified in 43.7% of the patients, the oral origin was predominant. Blood cultures were positive in only 34% of patients. Causative microorganism was staphylococcus in 43.6%, streptococcus in 43.6% and negative bacill gram in 17.4% of patients. Echocardiography showed vegetation in 98% of patients, cardiac abscess in 23.7% of patients and valve mutilation in 17.7% of cases. Prosthesis dehiscence was present in 4.5% of cases. Complications were primarily hemodynamic (57%) followed by embolic events (34%). Surgery occurred in 57.7% of patients, it was early in 69% of cases. The indication was mainly hemodynamic and mixed in 70%of patients. Hospital mortality was 28% with predictor’s factors: left heart (p=0.02), prosthesis (p <0.05), staphylococcus (p<0.005), heart failure (p<0.05) and neurological complications (p=0.04).
Conclusion: According to our study, infective endocarditis has always touched a young population in Tunisia, rheumatic valve disease is still the predominant underlying heart disease and both streptococcus and staphylococcus are most frequently isolated. Mortality remains high despite considerable progress in terms of diagnosis and therapy.

Keywords:

Infective endocarditis-echocardiography- microbiologycomplications- surgery

##plugins.themes.academic_pro.article.details##

References

  1. Tornos P, Gonzalez T, Thuny F, Habib G. Infective endocarditis: The Euro-pean viewer point. Curr Probl Cardiol 2011;36: 175- 222.
  2. Duval X, Hoen B. Evolution du profil épidémiologique des endocardites in-fectieuses. J anti inf 2011;13:155-160.
  3. Hogevik H, Olaison L, Anderson R et al. Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine Bal-timore 1995;74:324-39.
  4. Berlin JA, Abrutyn E, Storm BL, et al. Incidence of infective endocarditis in the Delaware Valley 1988-1990. Am J Cardiol 1995;76:933-6.
  5. Van der Meer JT, Thompson J, Valkenburg HA, et al. Epidemiology of bac-terial endocarditis in the Netherlands I. Patient characteristics. Arch Intern Med 1992;39:101-7.
  6. Parize P, Mainardi JL. Les actualités dans l'endocardite infectieuse. Rev Med Interne 2011;30:612-21.
  7. Letaief A, Boughzala E, Kaabia N et al. Epidemiology of infective endocardi-tis in Tunisia:a 10-year multicenter retrospective studying. Int J infect Dis 2007;11:430-33.
  8. Bennis A, Zahraoui M, Azzouzi L et al. L'endocardite bactérienne en milieu marocain. Ann Cardiol Angéiol 1995;44:339-44.
  9. Jalel S, Khan KA, Alai MS et al. Clinical spectrum of infective endocarditis: 15 years experience. Indian heart J 1998;50:516-29.
  10. Young SE. Aetiology and epidemiology of infective endocarditis in England and Wales. J Antimicrob Chemother 1987;20:7-14.
  11. Cetinkaya Y, Akova M, Akalin HE, et al. Retrospective review of 228 epi-sodes of infective endocarditis where rheumatic valvular disease is still com-mon. Int J Antimicrob Agents 2001;18:1-7.
  12. Murdoch DR, Corey GR, Hoen B, et al. Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st Century. Arch Intern Med 2009;169:463-73.
  13. Askoy O, Meyer LT, Cabell CH, et al. Gender differences in infective endo-carditis: pre- and co-morbid conditions lead to different management and out-comes in female patients. Scand J Infect Dis 2007;39:101-7.
  14. Sambola A, Fernández-Hidalgo N, Almirante B, et al. Sex differences in native valve infective endocarditis in a single tertiary-care hospital. Am J Car-diol 2010;106:92-8.
  15. Ben Smail M, Hannachi N, Kaabar Z, Rouge JF. Les endocardites infec-tieuses à propos de 120 cas. Info Cardiol 1986:877-904.
  16. Tleyjeh IM, Abdel-Latif A, Rahbi H et al. A systematic review of popula-tion-based studies of infective endocarditis. Chest 2007; 132:1025-35.
  17. Habib G, Thuny F, Avierinos JF. Prosthetic valve endocarditis: current ap-proach and therapeutic options. Prog Cardiovasc Dis 2008;50:274-81.
  18. Trabelsi I, Rekik S, Znazen A et al. Native Valve Infective Endocarditis in a Tertiary Care Center in a Developing Country (Tunisia). Am J Cardiol 2008;102:1247-51.
  19. Del Rio A, Anguera I, Miro JM, et al. Hospital Clinic Endocarditis Study Group. Surgical treatment of pacemaker and defibrillator lead endocarditis:the impact of electrode lead extraction on outcome. Chest 2003;124:1451-9.
  20. Duval X, Selton-Suty C, Alla F, et al. Endocarditis in patients with a per-manent pacemaker: a 1 year epidemiological survey on infective endocarditis due to valvular and/or pacemaker infection. Clin Infect Dis 2004;39:68-74.
  21. Netzer R, Zollinger E, Seiler C, Cerny A. Infective endocarditis: clinical spectrum, presentation and outcome, analysis of 212 cases. Heart 2000;3:184-96.
  22. Hoen B, Alla F, Selton-Suty C, et al. Changing profile of infective endo-carditis: results of a 1-year survey in France. JAMA 2002;288:75-81.
  23. Salgado A, Furlan AJ, Keys TF, Nichols TR, Beck GJ. Neurologic complica-tion of endocarditis: a 12 years experience. Neurology 1989;39:173-8.
  24. Roger M, Sandre D, Stephen D et al. Infective endocarditis : Review of 135 cases over 9 years. Clin infect Dis 1996;22:276- 86.
  25. Castillo JC, Anguita MP, Ramírez A. Long term outcome of infective endo-carditis in patients who were not drug addicts: a 10 year study. Heart 2000;83:525-530.
  26. Levine DP, Crane LR, Zervos MJ. Infectious endocarditis: a prospective comparative study. Rev Infect Dis 1986;8:374-96.
  27. Gergaud JM, Breux JP, Grollier G, Roblot P, Giraudon B. Aspects actuels de l'endocardite infectieuse à propos de 53 observations. Ann Med Interne 1994;145:163-7.
  28. Tariq M, Alam M, Munir G, Khan MA, Smego Jr. Infective endocarditis: a five-year experience at a tertiary care hospital in Pakistan. Int J Infect Dis 2004;8:163-70.
  29. Loupa C, Mavroidi N, Boutsikakis I, et al. Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data. Clin Microbiol Infect 2004;10:556-61.
  30. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med 2001;345:1318-30.
  31. Bouza E, Menasalvas A, Munoz P, Vasallo FJ, Moreno MD, FernandezMG. Infective endocarditis-a prospective study at the end of the twentieth century. Medicine (Baltimore) 2001;80:298- 307.
  32. Houpikian P, Raoult D. Blood culture-negative endocarditis in a reference center: Etiologic diagnosis of 348 cases. Medicine 2005;84:162-73.
  33. Habib G, Hoen B,Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009).The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 2009;30:2369-413.
  34. Heiro M, Nikoskelainen J, Engblom E, et al. Neurologic manifestations of in-fective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med 2000;160:2781-7.
  35. Corral I, Martin-Davila P, Fortun J, et al. Trends in neurological complica-tions of endocarditis. J Neurol 2007;254:1253-9.
  36. Duval X, Iung B, Klein I, et al. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med2010;152:497-504
  37. Hoen B, Alla F, Selton-Suty C, et al. Changing profile of infective endo-carditis: results of a 1-year survey in France. JAMA 2002;288:75-81.
  38. Mouly S, Ruimy R, Launay O et al. The changing clinical aspects of infective endocarditis: descriptive review of 90 episodes in a French teaching hospital and risk factors of death. J infect 2002;45:246-56.
  39. Tarmiz A, Jerbi S, Fradi MS, et al. Chirurgie de l'endocardite sur valves nati-ves à la phase active. Annales de Cardiologie et d'Angéiologie 2010;59:8-13.
  40. Guidelines on Prevention. Diagnosis and treatment of infective endocarditis executive summary: the task force on infective endocarditis of the european society of cardiology. Eur Heart J 2004;25:267-76.
  41. Practice guidelines (writting committee to revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the society of cardiovascular anesthesiologits endorsed by the society for cardiovascular angiography and interventions and the society of thoracic surgeons. J Am Coll cardiol 2006;48:598-675.
  42. Iung B, Rousseau-Paziaud J, Cormier B, et al. Contemporary results of mitral valve repair for infective endocarditis. J Am Coll Cardiol 2004;43:386-392.
  43. Skehan JD, Murray M, Mills PG. Infective endocarditis incidence and mortality in the North East Thames regions. Br Heart J 1988;59:62-8.
  44. Ninet J, André-Fouet X, Tabutin C, et al. Participation tricuspidienne au cours de l'endocardite infectieuse. Aspects actuels à propos de 13 observations. Rev Med Interne 1981;4:383-92.
  45. Carozza A, Renzulli A. tricuspid repair for infective endocarditis : clinical and echocardiographic results. Text Heart Inst J 2001;28:96-101.
  46. Bouchart F, Bessou JP, Tabley A, et al. Reinterventions sur prothèses valvulaires cardiaques à propos de 99 cas, Ann cardiol Angéiol 1994;43:532-6.
  47. Von Reyn CF, Levy BS, Arbeit RD, Friedland G, Crumpacker CS. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med 1981;94:505-18.
  48. Thomas D, Desruennes M, Jault F, Isnard R, Gandjbakhch I. Cardiac and extracardiac abscesses in bacterial endocarditis. Arch Mal Coeur Vaiss 1993;86:1825-35.
  49. Vikram HR, Buenconsejo J, Hasbun R, Quagliarello VJ. Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis. JAMA 2003;290:3207-14.
  50. Chu VH, Crosslin DR, Friedman JY, et al. Staphylococcus aureus bacteremia in patients with prosthetic devices: costs and outcomes. Am J Med 2005;118:141-6.
  51. Majumdar A, Chowdhary S, Ferreira MA, et al. Renal pathological findings in infective endocarditis. Nephrol Dial Transplant 2000;15:1782-7.
  52. Klein I, Iung B, Wolff M, et al. Silent T2 cerebral microbleeds: a potential new imaging clue in infective endocarditis. Neurology 2007;68:2043-52
  53. Anderson DJ, Goldstein LB, Wilkinson WE, et al. Stroke location, characteri-zation, severity, and outcome in mitral vs aortic valve endocarditis. Neurol-ogy 2003;61:1341-6.
  54. Roder BL, Wandall DA, Espersen F, et al. Neurologic manifestations in Staphylococcus aureus endocarditis: a review of 260 bacteremic cases in nondrug addicts. Am J Med 1997;102:379-86.
  55. Ruttmann E, Willeit J, Ulmer H, et al. Neurological outcome of septic cardi-oembolic stroke after infective endocarditis. Stroke 2006;37:2094-9.
  56. Sonneville R, Mirabel M, Hagège D, et al. Neurologic complications and outcomes of infective endocarditis in critically-ill patients: the ENDOREA prospective multicenter study. Crit Care Med 2011;1:10.
  57. Thuny F, Avierinos JF, Tribouilloy C, et al. Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: a prospective multicentre study. Eur Heart J 2007;28:1155- 61.
  58. Thomas D, Choussat R, Isnard R, et al. Abcès cardiaque dans l'endocardite infectieuse. Etude multicentrique à propos de 233 cas. Groupe de travail sur les valvulopathies de la société Française de Cardiologie. Arch Mal Coeur 1998;91:745-58.
  59. Anguera I, Miro JM, Vilacosta I, et al. Aortocavitary fistulous tract For infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality. Eur Heart J 2005;26:288-97.