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VOLUME 17 , ISSUE 3 ( June, 2013 ) > List of Articles


Infective endocarditis in an Indian setup: Are we entering the ′modern′ era?

Upendra Kaul, Amit Varma, Anu Gupta, Ashish Gupta

Keywords : Demographics, echocardiography, infective endocarditis, microbiologic characteristics, rheumatic heart disease

Citation Information : Kaul U, Varma A, Gupta A, Gupta A. Infective endocarditis in an Indian setup: Are we entering the ′modern′ era?. Indian J Crit Care Med 2013; 17 (3):140-147.

DOI: 10.4103/0972-5229.117041

License: CC BY-ND 3.0

Published Online: 01-06-2014

Copyright Statement:  Copyright © 2013; The Author(s).


Background: The clinical profile of infective endocarditis (IE) has been continuously evolving over last 3-4 decades as highlighted by many studies from developed world. Objectives: To evaluate the recent changes in the spectrum and clinical profile, and outcome of IE in an Indian setup. Materials and Methods: This was a descriptive, cross-sectional study. Demographic, clinical, characteristics, treatment, and outcome were examined in ′definite′ cases of IE admitted at our institute between July 2005 and December 2010. Results: 61 ′definite′ cases were identified. Mean patient age was 49.3 ± 13.7 years. Male to female ratio was 3.3:1. Rheumatic heart disease was the underlying heart disease in 23 (37.7%) patients. 33 (54.1%) patients had already received antibiotic therapy before presentation to us. Blood cultures were positive in 41 (67.2%) patients. Streptococci and staphylococci were the commonest microbial isolates, 9 (21.4%) patients each. Transesophageal echocardiography (TEE) was done for all the patients. Vegetations were detected in 54 (88%) patients. Surgery was done in 30 (49.2%) patients. In-hospital mortality happened in 4 (6.5%) patients. Conclusions: We recorded several new trends, like: 1) an increasing age, 2) an increasing proportion of patients with no previously known heart disease, 3) improving culture positivity rates, 4) rise in staphylococcal infections, 5) increased usage of TEE, 6) high elective surgical rate, and 7) apparent improved survival rates. These changes point to the fact that ′modern era′ changes in the profile of IE have started to appear in a selected population in India.

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  1. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis. Eur Heart J 2009;30:2369-413.
  2. Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O′Gara PT, et al. ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2008;118:887-96.
  3. Horstkotte D, Follath F, Gutschik E, Lengyel M, Oto A, Pavie A, et al. 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.
  4. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al. Infective endocarditis: Diagnosis, antimicrobial therapy, and management of complications: A statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: Endorsed by the Infectious Diseases Society of America. Circulation 2005;111:e394-434.
  5. Netzer RO, Zollinger E, Seiler C, Cerny A. Infective endocarditis: clinical spectrum, presentation and outcome. An analysis of 212 cases 1980-1995. Heart 2000;84:25-30.
  6. Moreillon P, Que YA. Infective endocarditis. Lancet 2004;363:139-49.
  7. Castillo JC, Anguita MP, Ramírez A, Siles JR, Torres F, Mesa D, et al. Long term outcome of infective endocarditis in patients who were not drug addicts: A 10 year study. Heart 2000;83:525-30.
  8. Hoen B, Alla F, Selton-Suty C, Béguinot I, Bouvet A, Briançon S, et al. Changing profile of infective endocarditis: Results of a 1-year survey in France. JAMA 2002;288:75-81.
  9. Tornos P, Iung B, Permanyer-Miralda G, Baron G, Delahaye F, Gohlke-Bärwolf Ch, et al. Infective endocarditis in Europe: Lessons from the Euro heart survey. Heart 2005;91:571-5.
  10. Ferreiros E, Nacinovich F, Casabé JH, Modenesi JC, Swieszkowski S, Cortes C, et al. EIRA-2 Investigators. Epidemiologic, clinical, and microbiologic profile of infective endocarditis in Argentina: A national survey. The Endocarditis Infecciosa en la República Argentina-2 (EIRA-2) Study. Am Heart J 2006;151:545-52.
  11. Prendergast BD. The changing face of infective endocarditis. Heart 2006;92:879-85.
  12. Cheng A, Athan E, Appelbe A, McDonald M. The changing profile of bacterial endocarditis as seen at an Australian provincial centre. Heart Lung Circ 2002;11:26-31.
  13. Choudhury R, Grover A, Varma J, Khattri HN, Anand IS, Bidwai PS, et al. Active infective endocarditis observed in an Indian hospital 1981-1991. Am J Cardiol 1992;70:1453-8.
  14. Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P, et al. Characteristics of infective endocarditis in a developing country: Clinical profile and outcome in 192 Indian patients, 1992-2001. Int J Cardiol 2005;98:253-60.
  15. Tariq M, Siddiqui BK, Jadoon A, Alam M, Khan SA, Atiq M, et al. Clinical profile and outcome of infective endocarditis at the Aga Khan University Hospital. Int J Collab Res Internal Med Public Health 2009;1:84-99.
  16. Khan NU, Farman MT, Sial JA, Achakzai AS, Saghir T, Ishaq M. Changing trends of infective endocarditis. J Pak Med Assoc 2010;60:24-7.
  17. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633-8.
  18. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001;345:1318-30.
  19. van der Meer JT, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in the Netherlands. Arch Intern Med 1992;152:1863-8.
  20. Delahaye F, Goulet V, Lacassin F, Ecochard R, Selton-Suty C, Hoen B, et al. Characteristics of infective endocarditis in France 1991. A 1-year survey. Eur Heart J 1995;16:394-401.
  21. Piper C, Körfer R, Horstkotte D. Prosthetic valve endocarditis. Heart 2001;85:590-3.
  22. Strom BL, Abrutyn E, Berlin JA, Kinman JL, Feldman RS, Stolley PD, et al. Dental and cardiac risk factors for infective endocarditis: A population-based, case-control study. Ann Intern Med 1998;129:761-9.
  23. Delahaye F, Rial MO, de Gevigney G, Ecochard R, Delaye J. A critical appraisal of the quality of the management of infective endocarditis. J Am Coll Cardiol 1999;33:788-93.
  24. Cabell CH, Jollis JG, Peterson GE, Corey GR, Anderson DJ, Sexton DJ, et al. Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 2002;162:90-4.
  25. Evangelista A, Gonzalez-Alujas MT. Echocardiography in infective endocarditis. Heart 2004;90:614-7.
  26. Heidenreich PA, Masoudi FA, Maini B, Chou TM, Foster E, Schiller NB, et al. Echocardiography in patients with suspected endocarditis: A cost-effectiveness analysis. Am J Med 1999;107:198-208.
  27. Kabde VR, Bidwai PS, Berry JN, Agarwal KC. Clinical and bacteriological studies in infective endocarditis. Indian Heart J 1970;22:318-32.
  28. Agarwal RK, Gupta R, Agarwal SC, Dwivedi M. Bacterial endocarditis-its diagnostic problems. J Assoc Physicians India 1981;29:745-50.
  29. Sadiq M, Nazir M, Sheikh SA. Infective endocarditis in children-incidence, pattern, diagnosis and management in a developing country. Int J Cardiol 2001;78:175-82.
  30. Beynon RP, Bahl VK, Prendergast BD. Infective endocarditis. BMJ 2006;333:334-9.
  31. 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.
  32. Alexiou C, Langley SM, Stafford H, Lowes JA, Livesey SA, Monro JL. Surgery for active culture-positive endocarditis: Determinants of early and late outcome. Ann Thorac Surg 2000;69:1448-54.
  33. Delahaye F, Celard M, Roth O, de Gevigney G. Indications and optimal timing for surgery in infective endocarditis. Heart 2004;90:618-20.
  34. Sexton DJ, Spelman D. Current best practices and guidelines. Assessment and management of complications in infective endocarditis. Infect Dis Clin North Am 2002;16:507-21.
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