Infective endocarditis in the Pacific: clinical characteristics, treatment and long-term outcomes

Abstract

IntroductionData on clinical characteristics and outcomes of infective endocarditis (IE) in the Pacific are scarce.MethodsRetrospective hospital-based study in New Caledonia, a high-income country, on patients aged over 18 years with definite IE according to the modified Duke criteria (2005–2010).Results51 patients were included: 31 (60.8%) men; median age of 52.4 years (IQR 33.0–70.0). Left-sided IE accounted for 47 (92.2%) patients: native valve IE in 34 (66.7%) and prosthetic valve IE in 13 (25.5%). The main underlying heart disease included: rheumatic valve disease in 19 (37.3%), degenerative heart valve disease in 12 (23.5%) and congenital heart disease in 6 (11.8%). Significant comorbidities (Charlson's score >3) were observed in 20 (38.7%) patients. Infection was community acquired in 43 (84.3%) patients. Leading pathogens included Staphylococcus aureus in 16 (31.4%) and Streptococcus spp in 15 (29.4%) patients. Complications were noted in 33 patients (64.7%) and 24 (47.1%) were admitted to the intensive care unit. Cardiac surgery was eventually performed in 22 of 40 (55.0%) patients with a theoretical indication. None underwent emergent cardiac surgery (ie, first 24 h); 2 (3.9%) were operated within 7 days; and 20 (39.2%) beyond 7 days. 11 (21.6%) patients died in hospital and 21 (42.9%) were dead after a median follow-up of 28.8 months (IQR 4.6–51.2). Two (3.9%) were lost to follow-up.ConclusionsIn New Caledonia, IE afflicts relatively young patients with rheumatic heart disease, and carries high complication and mortality rates. Access to heart surgery remains relatively limited in this remote archipelago.

Factors Affecting Mortality in Patients with Blood-Culture Negative Infective Endocarditis

“…These relatively younger patients can be explained by the higher incidence of congenital and rheumatic heart diseases in the developing countries. 12,13,15 With the similar proportion of congenital and rheumatic heart diseases in this study (17.8%), it is to be noted that valvular degeneration remains the most commonly encountered predisposing factors in this study (46.6%). This differs with several other studies in southeast Asia which stated that IE is most commonly found in rheumatic heart disease patients.…”

“…This result is in accordance with several other studies with a population of both culture positive and negative IE. 2,9,13,15 Majority of patients in this study showed an excellent LV function ranging between 80 and 85%. This finding is in accordance with another study which reported that the majority of patients with IE maintain a good ejection fraction.…”

“…A study in Laos by Mirabel et al stated that none of their patients undergo surgery; however, the absence of patients undergoing surgery at the study is caused by the limited resource at the facility. 12,15 It is to be noted that studies in developed countries reported a much higher rate of surgery at 55%. 19 The mortality rate of culture-negative IE in this study was 13.5% (22 out of 162 patients), which is higher than the mortality rate in patients with culture-positive IE (10.6%).…”

Sobrevida a 10 años de pacientes egresados luego de cirugía por endocarditis infecciosa en un hospital público

“…En las distintas series, ya sea de pacientes quirúrgicos o del total de EI e independiente del tratamiento, la presencia de EI sobre prótesis valvular representa entre 25% hasta 41% de los casos 10,19,20,[22][23][24] . Si bien lo encontrado en este estudio es significativamente menor, es comparable a 9% a 28% reportado en series nacionales 12 .…”

A massive haemothorax as an unusual complication of infective endocarditis caused byStreptococcus sanguinis

“…2 However, the underlying heart diseases in patients with infective endocarditis include rheumatic valve disease, degenerative heart valve disease and congenital heart disease. 3 Particularly, in the Republic of Korea, the most common type of underlying heart disease in patients who develop infective endocarditis is rheumatic heart disease, followed by congenital heart disease. 4 Streptococcus viridans is the most commonly isolated microorganism, followed by Staphylococcus aureus.…”