Profile of Infective Endocarditis: At a Tertiary Care Referral Centre.

Infective endocarditis (IE) remains a serious challenge with a persistently high morbidity and mortality despite the availability of improved diagnostic and treatment amenities in the developing world. Data on the clinical and microbiological profile of IE in India is still limited. The emergence of modern risk factors such as hospitalization and device insertion has changed the epidemiology of the disease in the western world, whereas in India and other parts of the developing world the situation is more complex because of the concomitant burden of rheumatic heart disease and congenital heart defects. We therefore attempted to describe the changing epidemiology of the disease in a cohort of patients with definite IE admitted to a tertiary care centre. 145 cases were identified as IE during the period January 2010-December 2015 (6 years) of which 120 'definite' cases of IE according to the modifies Dukes' criteria were analysed. The mean age of patients was 53 years ± 15 years (age range 18 to 79 years) with a male preponderance of 72%. Native valve disease was seen in 103 cases and 17 cases had prosthetic valve infections. IE was classified as community acquired in 87 (72.5%) cases and healthcare associated in 33(27.5%) events. Predisposing factors contributing to healthcare associated events included hemodialysis in 8.3%, recent surgical intervention which included urological instrumentation with urosepsis and gastrointestinal procedures in 5.8% events. Postpartum IE was seen in 1.7% cases. There was evidence of remote abscess, prior bacteraemia or septic foci in the preceding 3 months of presentation with IE in 8.3% of patients and 3.3% patients underwent prior dental procedure. Prior structural heart disease was present in 47.5% of cases of which Rheumatic heart disease (RHD) was seen in 15%. A previous episode of infective endocarditis was observed in significantly more patients with PVE (29.4%) than with NVE (1.9%). Blood cultures were negative in 50 (41.7%) of cases of whom 60% had received antibiotics prior to admission. Nine of 17 patients with PVE (52.9%) were culture negative. In the 70(58.3% of all patients) patients with positive blood cultures, Streptococcus sp were the commonest bacteria isolated in 15.8%, of which Viridans group Streptococci (VGS) was seen in majority of the cases (13.3%) followed by Staphylococcus sp (14.2%) with methicillin resistant staphylococcus was seen in 3.3% and Enterococcus sp in 13.3%. Gram negative bacteraemia were seen in 8.3%. In addition, ESBL E coli constituted 4% of our culture positive cases, perhaps representing a complication of this common community acquired bacteraemia and increasing resistance in E coli. Tissue / valve cultures in patients who underwent surgery was positive in four cases, 3 of whom where blood culture negative The mortality rate was higher among PVE (33%) compared to 10% in NVE. The most common cause of death in IE was usually congestive cardiac failure. Thought Rheumatic heart disease continues to be the most common predisposing factor, degenerative heart diseases and healthcare associated IE are also gradually increasing. Use of antibiotics prior to sending blood cultures remains a significant cause of culture negativity. Viridans streptococci continue to be the commonest pathogen and though ESBL E coli constituted a significant minority it could expound the changing epidemiology and risk factors for Gramnegative endocarditis especially non-HACEK group necessitating an updated review of this subject.

R M ，V R ，Nambi PS ，Ramakrishnan B ，Gopalakrishnan R ，Sathyamurthy ... -  《-》

Profile, presentation and outcomes of prosthetic valve endocarditis in a South African tertiary hospital: Insights from the Groote Schuur Hospital Infective Endocarditis Registry.

Mkoko P ，Cupido BJ ，Hitzeroth J ，Chin A ，Ntsekhe M ... -  《-》

Implications for Diagnosis and Treatment of Infective Endocarditis: Eight year Experience of an Infectious Disease Team in a Private Tertiary Care Centre.

The profile of Infective endocarditis (IE) has been evolving continuously. Like other infectious Diseases (ID) syndromes, IE has not escaped from antibiotic resistance issues. The aim of this study was to determine the implications for diagnosis and treatment by studying the clinical profile and outcome of patients admitted with IE in a tertiary care centre in Mumbai during the period from 2007-2015. 53 patients having definite or possible IE as per Modified Duke's Criteria (MDC), that were referred to the ID division, were included in this study. 44 (83%) patients had definite IE and 9 (17%) patients had possible IE. 77.4% of the patients were above 40 years of age. 3 patients presented as euthermic IE. Vegetations were not seen on transthoracic echocardiography (TTE) in 3 patients and were seen only on transesophageal echocardiography (TEE). 15 patients had prosthetic valve IE. 7 patients had rheumatic heart disease. 3 patients had bicuspid aortic valve and 4 had ventricular septal defect (VSD). The rest had no apparent underlying heart disease (45.3%). 41 patients (77.3%) had culture-positive IE and 12 patients (22.6%) had culture-negative IE. Streptococcus spp. was found in 14 (26.4%) patients, Enterococcus spp. in 9 patients (17%). Other organisms isolated were methicillin-sensitive S. aureus (3), Methicillin Resistant S. aureus (1), Eikenella corrodens (1), B. cepacia (2), Salmonella Typhi (1), P. aeruginosa (1), M. abscessus (2) and other rapidly growing mycobacteria (RGM) (5), Candida parapsilosis (1), Candida pelliculosa (1) and Aspergillus fumigatus (1). Notably there was only one case of MRSA. Among the Streptococcus spp., Penicillin MIC testing was done in 11 cases of the 14 cases of Strep spp. 3 of them showed intermediate resistance and 2 were resistant. Among enterococcal IE, 3 had high level aminoglycoside resistance (HLAR) and 2 had β-lactamase producing enterococci with HLAR and 1 had Vancomycin resistance. These were successfully treated with combinations of Ampicillin with Ceftriaxone, Ampicillin-Sulbactam with Imipenem and Daptomycin respectively. The only case of MRSA prosthetic valve endocarditis was successfully treated with Vancomycin and Rifampicin in addition to surgery. Surgery for IE was performed in 26 out of 53 (49%) patients. Early valve surgery (within 15 days of hospital admission) was performed in 6 of these 26 patients. . There is a change in the spectrum and antimicrobial susceptibility of organisms causing IE. We encountered several difficulties with the use of the MDC as 43.5% patients had no predisposing factors for IE and blood cultures were negative in 22.6% cases. In our study, PVE was the most common predisposing condition for IE. VGS followed by enterococci were found to be the commonest cause for IE in our setting. Both organisms show variable drug resist patterns. MRSA was isolated in 1 patient only. Thus vancomycin may not be required as empiric treatment in our setting. This is important from the perspective of antimicrobial stewardship Good infection control practices are essential to prevent nosocomial IE due to pathogens such as non-tuberculous mycobacteria (NTM). Important changes in the disease characteristic, treatment, and outcome are noted. Surgery, whenever indicated, helps in improving outcome in these patients thus reiterating the need for a team approach for optimal management of this complex, challenging condition..

Soman R ，Gupta N ，Chaudhari P ，Sunavala A ，Shetty A ，Rodrigues C ... -  《-》

Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data.

Loupa C ，Mavroidi N ，Boutsikakis I ，Paniara O ，Deligarou O ，Manoli H ，Saroglou G ... -  《CLINICAL MICROBIOLOGY AND INFECTION》

Cumulative incidence and mortality of infective endocarditis in Siriraj hospital-Thailand: a 10-year retrospective study.

Angsutararux T ，Angkasekwinai N 《BMC INFECTIOUS DISEASES》