Abstract
ObjectivesWe aimed to evaluate the microbiological characteristics and risk factors for mortality of infective endocarditis in two tertiary hospitals in Ho Chi Minh City, south Vietnam.Materials and methodsA retrospective study of 189 patients (120 men, 69 women; mean age 38 ± 18 years) with the diagnosis of probable or definite infective endocarditis (IE) according to the modified Duke Criteria admitted to The Heart Institute or Tam Duc Hospital between January 2005 and December 2014.ResultsIE was related to a native valve in 165 patients (87.3%), and prosthetic valve in 24 (12.7%). Of the 189 patients in our series, the culture positive rate was 70.4%. The most common isolated pathogens were Streptococci (75.2%), Staphylococci (9.8%) followed by gram negative organism (4.5%). The sensitivity rate of Streptococci to ampicillin, ceftriaxone or vancomycin was 100%. The rate of methicillin resistant Staphylococcus aureus was 40%. There was a decrease in penicillin sensitivity for Streptococci over three eras: 2005–2007 (100%), 2008–2010 (94%) and 2010–2014 (84%). The in-hospital mortality rate was 6.9%. Logistic regression analysis found prosthetic valve and NYHA grade 3 or 4 heart failure and vegetation size of more than 15 mm as strong predictors of in-hospital mortality.ConclusionStreptococcal species were the major pathogen of IE in the recent years with low rates of antimicrobial resistance. Prosthetic valve involvement, moderate or severe heart failure and vegetation size of more than 15 mm were independent predictors for in-hospital mortality in IE.
Highlights
Despite major advances in therapeutic and diagnostic options, mortality and morbidity associated with infective endocarditis (IE) has not decreased significantly in the past four decades [1]
IE was related to a native valve in 165 patients (87.3%), and prosthetic valve in 24 (12.7%)
As recent IE treatment recommendations are significantly based on non-randomized studies and expert opinion [5, 6], empiric antibiotic therapy is usually applied based on local microbiological characteristics
Summary
Despite major advances in therapeutic and diagnostic options, mortality and morbidity associated with infective endocarditis (IE) has not decreased significantly in the past four decades [1] This may be related to factors such as increased frequency of age-related valvular degeneration, prosthetic-valve surgery, and hospital-related infections that change the microbial flora and antibiotic susceptibility [1,2,3,4]. As recent IE treatment recommendations are significantly based on non-randomized studies and expert opinion [5, 6], empiric antibiotic therapy is usually applied based on local microbiological characteristics. For this reason, it is essential to periodically update information about regional IE pathogen characteristics and antibiotic susceptibility profile.
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