0275: Diagnosis, complications and management of infective endocarditis: experience of Tunisian military hospital

Abstract

Infective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease – mostly chronic rheumatic heart disease – IE nowadays tends to affect older patients and new at-risk groups, including intravenous-drug users, patients with intracardiac devices and degenerative valvular heart disease… We aimed to evaluate demographic data, underlying cardiac abnormalities, clinical profile, microbiological features, treatments and complications of IE. A retrospective study of all cases with the diagnosis of definite endocarditis according to Duke Criteria admitted to The Tunisian Military Hospital between January 2001 and December 2007. The study included 53 patients (32 males and 21 females; mean age 44.5 ± 16.5 years). Infective endocarditis developed on a native valve in 48 patients (90%), a mechanical prosthetic valve in 5 patients (5%). Rheumatic heart disease in 26 cases (49%) was the most common preexisting valvular abnormality in native valve endocarditis. The mitral valve was the most commonly affected valve 23 (43.4%). Fever occurred in 50 (94%) of the cases. Trans-thoracic and/or trans-esophageal echocardiography showed vegetation and/or abcess in 33 patients (62.2%). Streptococci in 17 cases (32%) and Staphylococci in 13 cases (24%) were the most common causative agents. Twenty-six patients (49%) underwent surgical treatment. Cardiac complications occurred in 13% of cases, vascular complications in 18% of cases, cerebrovascular accidents in 15% of cases and septic metastatic complications in 15% of cases. IE usually occurred on rheumatic heart disease. Its diagnosis is based on hemocultures and echocardiography. There are deficiencies in applying prophylaxis, which is a justification for the improvement of patient management through education.