Epidemiology of infective endocarditis in Africa: a systematic review and meta-analysis

Abstract

BackgroundThe epidemiology of infective endocarditis in Africa is inadequately characterised. We therefore aimed to comprehensively summarise the available data for the incidence, risk factors, clinical pattern, microbiology, and outcomes of infective endocarditis in Africa. MethodsWe did a systematic review and meta-analysis. We searched PubMed, Embase, African Index Medicus, and African Journals Online for all studies reporting primary data for the epidemiology of infective endocarditis in populations within Africa, published from inception to Jan 14, 2021, irrespective of the language. We used the search terms "endocarditis", "Africa", and the name of all African countries in the search strategy. We excluded articles that did not include primary data, primary studies with a small sample size (<30 participants), and those that report findings from before 1990. We recorded data for study characteristics, sample size, criteria used to define infective endocarditis, risk factors, potential entry site, clinical patterns, microbiology profile, outcomes including complications such as embolic events, heart failure, acute kidney injury, and death, and predictors of death. We used random-effects meta-analysis method to pool estimates. This study is registered with PROSPERO, CRD42021243842. FindingsWe retrieved 2141 records from the database and bibliographic searches, of which a total of 42 studies were included in this systematic review. Rheumatic heart disease was the most common risk factor for infective endocarditis in adults (52•0% [95% CI 42•4-61•5]), whereas congenital heart disease was the most common risk factor for infective endocarditis in children (44•7% [29•5-60•5]). Microbiological testing (mostly blood cultures) was positive in 48•6% (95% CI 42•2-51•1) of patients with infective endocarditis, with Staphylococcus species (41•3% [95% CI 36•2-46•5]) and Streptococcus species (34•0% [29•0-39•3]) the most commonly identified microorganisms. The pooled rate of surgical treatment of infective endocarditis was 49•1% (95% CI 43•2-55•1). The pooled in-hospital mortality rate was 22•6% (95% CI 19•5-25•9). Other frequent complications included heart failure (47•0% [95% CI 38•2-56•0]), acute kidney injury (22•8% [18•8-27•0]), and embolic events (31•1% [22•2-40•7]). Interpretation As the most prevalent risk factor in Africa, rheumatic heart disease should be central in interventions to reduce the burden of infective endocarditis on the continent. In tertiary hospitals with good access to cardiac surgery, the outcomes of infective endocarditis seem relatively similar to what has been reported in other parts of the world, especially in high-income countries.

Risk factors and diagnostic value of urinary N-terminal pro-brain natriuretic peptide for verification of heart failure in human immunodeficiency virus-infected patients

“…По данным эпидемиологических исследований до 47% больных с инфекционным эндокардитом имеют симптомы и признаки ХСН [16]. Несмотря на то, что результаты ретроспективных обсервационных исследований показывают, что в последние годы распространенность инфекционных эндокардитов снижается у ВИЧ-инфицированных больных в США с 148,0 в 2007г до 112,1 на 100 тыс.…”

Infective endocarditis in developing countries: An update

“…To the best of our knowledge, little is known about IE in developing countries due to a lack of adequate studies in this area. Rheumatic heart disease (RHD) and congenital heart disease (CHD) have been reported as the most common cause of IE ( 3 , 12 ). Studies have shown that, in developing countries, optimal medical and surgical management is limited ( 12 ).…”

“…Rheumatic heart disease (RHD) and congenital heart disease (CHD) have been reported as the most common cause of IE ( 3 , 12 ). Studies have shown that, in developing countries, optimal medical and surgical management is limited ( 12 ). In these countries, microorganisms are reported to be unidentified due to poor diagnostic capacity ( 3 ).…”

“…In these countries, microorganisms are reported to be unidentified due to poor diagnostic capacity ( 3 ). Moreover, studies have shown that patients have more complications due to delays in diagnosis and late hospital presentation ( 3 , 12 ).…”

“…Recently, in developing countries, there has been an increase in the use of prosthetic and intra-cardiac devices which are other risk factors of IE ( 12 ). Patients who are at risk of developing IE also include those who visit the healthcare system for other comorbidities, for example, immunosuppressed patients ( 1 , 5 ).…”