Iranian Journal of Microbiology 2017. 9(5):257-263.

Clinicomicrobiological spectrum of infective endocarditis - from a tertiary care centre in south India
Kanne Padmaja, Sukanya Sudhaharan, Lakshmi Vemu, Oruganti Sai Satish, Padmasri Chavali, Mamidi Neeraja

Abstract


Background and Objectives: Infective endocarditis (IE) is a microbial infection of the endothelial surface of the cardiacvalves. Rapid diagnosis, effective treatment and prompt recognition of complications are essential, in order to improve the outcome. We retrospectively reviewed and determined the clinical characteristics, microbiological profile and management strategies of IE cases, changing microbial spectrum of pathogens and outcome in Native Valve Endocarditis (NVE) and Prosthetic Valve Endocarditis (PVE) cases.


Materials and Methods: We retrospectively reviewed the medical records of 191 patients, clinically diagnosed with IE, based on modified Dukes criteria, from January 2011 to December 2016. Blood cultures received from all these patients were processed, using BacT/Alert system (bioMerieux, Marcy l'Etoile, France).


Results: Sixty eight (68/191) cases were positive for bacterial pathogens. Twenty four (24/191) cases had PVE and 167/191 had NVE. Nineteen cases (19/24, 79.1%) were PVE positive and forty nine (49/167, 29.3%) were NVE positive. Culture negative endocarditis cases were 123/191 (64.39%). The most common pathogen isolated from NVE cases, in our study was Streptococcus mitis, followed by methicillin-resistant coagulase negative staphylococcus (MRCONS) in PVE. The NVE were treated intravenously with a combination of a β-lactam or glycopeptide with an aminoglycoside, for prolonged period of 4-6 weeks, with a successful outcome. The PVE cases were treated with the appropriate antibiotics as per the antibiotic susceptibility report.


Conclusion: The high morbidity and mortality rates are associated with IE and hence accurate identification of aetiological agents and appropriate antimicrobial therapy is required.


Keywords


Native valve endocarditis, Prosthetic valveendocarditis, Congestive heart failure

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References


Kucukates E, Gultekin N, Bagdatli Y. Cases of active infective endocarditis in a university hospital during a 10-year period. J Pak Med Assoc 2013;63:1163-1167.

Khan NU, Farman MT, Sial JA, Achakzai AS, Saghir T, Ishaq M. Changing trends of infective endocarditis. J Pak Med Assoc 2010;60:24-27.

Beynon RP, Bahl VK, Prendergast BD. Infective endocarditis. BMJ 2006; 333:334-339.

Senthilkumar S, Menon T, Subramanian G. Epidemiology of infective endocarditis in Chennai, South India. Indian J Med Sci 2010;64:187-191.

Nunes MC, Gelape CL, Ferrari TC. Profile of infective endocarditis at a tertiary care center in Brazil during a seven-year period: prognostic factors and in-hospital outcome. Int J Infect Dis 2010;14:e394-398.

Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH. Mortality from infective endocarditis: clinical predictors of outcome. Heart 2002;88:53-60.

Ghosh S, Sahoo R, Nath RK, Duggal N, Gadpayle AK. A study of clinical, microbiological, and Echocardiographic profile of patients of infective endocarditis. Int Sch Res Notices 2014;2014:340601.

Gupta A, Gupta A, Kaul U, Varma A. Infective endocarditis in an Indian setup: Are we entering the ‘modern’ era? Indian J Crit Care Med 2013;17:140-147.

Nunes MC, Gelape CL, Ferrari TC. Profile of infective endocarditis at a tertiary care center in Brazil during a seven-year period: prognostic factors and in-hospital outcome. Int J Infect Dis 2010;14:e394-398.

Agca FV, Demircan N, Peker T, Ari H, Karaagac K, Ozluk OA, et al. Infective endocarditis: a tertiary referral centre experience from Turkey. Int J Clin Exp Med 2015;8:13962-13968.

Kothari SS, Ramakrishnan S, Bahl VK. Infective endocarditis--an Indian perspective. Indian Heart J 2005; 57: 289-294.

Jain SR, Prajapati JS, Phasalkar MA, Roy BH, Jayram AA, Shah SR, Singh T, et al. Clinical spectrum of infective endocarditis in a tertiary care centre in western India: A prospective study. IJCM 2014;5:177-187.

Tuğcu A, Yildirimtürk O, Baytaroğlu C, Kurtoğlu H, Köse O, Sener M, et al. Clinical spectrum, presentation, and risk factors for mortality in infective endocarditis: a review of 68 cases at a tertiary care center in Turkey. Turk Kardiyol Dern Ars 2009;37:9-18.

Hosseini SM, Bakhshian R, Moshkani Farahani M, Abdar Esfahani M, BahramiA, Sate A. An observational study on infective endocarditis: A single center experience. Res Cardiovasc Med 2014;3(4):e18423.

Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century. Arch Intern Med 2009;169:463-473.

Loupa C, Mavroidi N, Boutsikakis I, Paniara O, Deligarou O, Manoli H, et al. Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data. Clin Microbiol Infect 2004;10:556-561.

Siddiqui BK, Tariq M, Jadoon A, Alam M, Murtaza G, Abid B, et al. Impact of prior antibiotic use in culture-negative endocarditis: review of 86 cases from southern Pakistan. Int J Infect Dis 2009;13:606-612.

Derber C, Elam K, Forbes BA, Bearman G. Achromobacter species endocarditis: A case report and literature review. Can J Infect Dis Med Microbiol 2011;22(3): e17-e20.

Padmaja K, Lakshmi V, Amaresh MR, Mishra RC, Chikkala R. Prosthetic valve endocarditis with aortic root abscess due to Achromobacter denitificans a case report. Int J Infect Control 2013:9(1)1-5.

Lin CH, Hsu RB. Infective endocarditis caused by nutritionally variant streptococci. Am J Med Sci 2007;334: 235-239.

Giuliano S, Caccese R, Carfagna P, Vena A, Falcone M, Venditti M. Endocarditis caused by nutritionally variant streptococci: a case report and literature review. Infez Med 2012;20:67-74.

Padmaja K, Lakshmi V, Subramanian S, Neeraja M, Krishna SR, Satish OS. Infective endocarditis due to Granulicatella adiacens: a case report and review. J Infect Dev Ctries 2014;8:548-550.

Taimur S, Madiha R, Samar F, Bushra J. Gemella morbillorum endocarditis in a patient with a bicuspid aortic valve. Hellenic J Cardiol 2010; 51:183-186.

Keles C, Bozbuga N, Sismanoglu M, Guler M, Erdogan HB, Akinci E, et al. Surgical treatment of Brucella endocarditis. Ann Thorac Surg 2001;71:1160-1163.

Inan MB, Eyileten ZB, Ozcinar E, Yazicioglu L, Sirlak M, Eryilmaz S, et al. Native valve Brucella endocarditis. Clin Cardiol 2010;33(2):E20-E26.

Wilson AP. The return of Corynebacterium diphtheriae: the rise of non- toxigenic strains. J Hosp Infect 1995; 30:306-312.

Padmaja K, Lakshmi V, Sandhya K, Satish OS , Kumar KLN, Amaresh MR, et al. Native valve endocarditis due to non toxigenic strain of Corynebacterium diphtheria in a child: case report & review of litterature. J Immunol Tech Infect Dis 2016; 5:3.

Lakshmi S, Rai MP, Castro JG. Stenotrophomonas maltophilia endocarditis of the native aortic valve: case report and review of literature. Infect Dis Clin Pract 2015;23(5):231-234.

Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American heart association circulation. JADA 2007;116:1736-1754.


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