Abstract
BackgroundStaphylococcus has replaced streptococcus as the most common cause of infective endocarditis (IE) in developed health care systems. The trend in developing countries is less clear.AimTo examine the epidemiological trends of infective endocarditis in a developing nation.MethodsSingle-centre, retrospective study of patients admitted with IE to a tertiary hospital in Malaysia over a 12-year period.ResultsThe analysis included 182 patients (n = 153 Duke’s definite IE, n = 29 possible IE). The mean age was 51 years. Rheumatic heart disease was present in 42%, while 7.6% were immunocompromised. IE affected native valves in 171 (94%) cases. Health-care associated IE (HCAIE) was recorded in 68 (37.4%). IE admission rates increased from 25/100,000 admissions (2012) to 59/100,000 admissions (2017). At least one major complication on admission was detected in 59 (32.4%) patients. Left-sided IE was more common than right-sided IE [n = 159 (87.4%) vs. n = 18 (9.9%)]. Pathogens identified by blood culture were staphylococcus group [n = 58 (40.8%)], streptococcus group [n = 51 (35.9%)] and Enterococcus species [n = 13 (9.2%)]. staphylococcus infection was highest in the HCAIE group. In-hospital death occurred in 65 (35.7%) patients. In-hospital surgery was performed for 36 (19.8%) patients. At least one complication was documented in 163 (85.7%).ConclusionStaphylococcus is the new etiologic champion, reflecting the transition of the healthcare system. Streptococcus is still an important culprit organism. The incidence rate of IE appears to be increasing. The rate of patients with underlying rheumatic heart disease is still high.
Highlights
Infective endocarditis (IE) is a universal disease with risk factors, predispositions and outcomes considered similar across continents for decades
Reductions in infective endocarditis (IE) mortality rates that had been anticipated with improved medical care did not materialize due to the changing epidemiology and the coinciding higher rates of Health-care associated IE (HCAIE) [1, 4, 5]
The folders of 29 patients treated for IE between 2005 and 2007 were incomplete or could not be retrieved
Summary
Infective endocarditis (IE) is a universal disease with risk factors, predispositions and outcomes considered similar across continents for decades. An epidemiological transition has been reported over the past decade for developed health care systems where viridans streptococcus. Reductions in IE mortality rates that had been anticipated with improved medical care did not materialize due to the changing epidemiology and the coinciding higher rates of HCAIE [1, 4, 5]. It is not clear whether developing countries undergo an epidemiological transition of IE to the same extent. Staphylococcus has replaced streptococcus as the most common cause of infective endocarditis (IE) in developed health care systems.
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