Clinical – microbiological characterization and risk factors of mortality in infective endocarditis from a tertiary care academic hospital in Southern India

Abstract

Aims: To dissect the clinical-microbiological profile of Infective endocarditis (IE) population and to determine the risk factors for IE related mortality. Methods: A cohort study was conducted using relevant data from clinical records of patients (≥12 years) with definite/possible IE from December 2007 to December 2013 and was analyzed using appropriate statistical tests. Results: In the cohort of 139 IE patients, mean age was 47.9 ± 15.8 years, with male preponderance (68.3%). Rheumatic heart disease was the commonest (30.9%) underlying cardiac lesion followed by mitral valve prolapse with mitral regurgitation (23.7%), degenerative valvular disease (23%), congenital heart disease (15.8%) and prosthetic valves (3.6%). Vegetations were detected in 94.2% cases. Blood cultures were positive in 69.8% cases, commonest organism isolated was α – hemolytic streptococci (30.9%) followed by Enterococcus (12.9%) and methicillin sensitive Staphylococcus aureus (10.8%). Complications observed were congestive cardiac failure (31.2%), acute kidney injury (25.9%), stroke (21.6%), septic shock (16.5%), embolic phenomenon non-stroke (8.6%), atrial fibrillation (5%) and ring abscess (2.9%). Mortality rate was 17.3%. Congestive cardiac failure, increase in the peak leucocyte count and stroke were the independent predictors of mortality. Conclusions: This study reiterates the persistent dominance of rheumatic heart disease in the population studied and α – hemolytic Streptococci as the commonest responsible microorganism. Keywords: Infective endocarditis, α – Hemolytic streptococci, Rheumatic heart disease, Mitral regurgitation