Abstract
BackgroundFew data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years.ResultsThe IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007).ConclusionThis Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.
Highlights
Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt
Rheumatic heart disease (RHD) is a less common risk factor, whereas degenerative valve disease in older individuals, mitral valve prolapse, intravenous drug use (IVDU), prosthetic valves, or devices have become the most common reasons for IE, coinciding with an increase in IE caused by staphylococcal infections and some fastidious organisms [1, 3]
We reviewed all cases of IE referred to a tertiary care facility in Egypt and developed a registry with the goal of describing the clinical features and outcome of patients over a decade
Summary
Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. Infective endocarditis (IE) remains an evolving disease with high morbidity and mortality even in the modern era of advanced diagnostic imaging, improved antimicrobial chemotherapy, and potentially curative surgery [1]. Despite these improvements in diagnosis and management, the incidence of the disease is unchanged over the past two decades at approximately 1.7–6.2 cases per 100,000 per year [1] and has not appreciably changed recently. Rheumatic heart disease (RHD) is a less common risk factor, whereas degenerative valve disease in older individuals, mitral valve prolapse, intravenous drug use (IVDU), prosthetic valves, or devices have become the most common reasons for IE, coinciding with an increase in IE caused by staphylococcal infections and some fastidious organisms [1, 3]. Pathogens that were previously difficult to detect and evolving multi-drug-resistant bacteria pose a challenge to the conventional therapeutic armamentarium [2].
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