P265 Infective endocarditis:think global, act local:changing trends in infective endocarditis-integrating antibiotic stewardship program: data from developing world

Abstract

Abstract Despite improvements in diagnostic and therapeutic strategies, both the incidence, severity & mortality of Infective Endocarditis (IE) seem to be unchanged.The pattern of the disease in terms of host, agent & environment changing rapidly.The successful integration of antibiotic stewardship program along with the appropriate use of antibiotic agents has made a huge difference in the treatment strategy & cost reduction in patient care for IE. Materials & Methods: A single centre, retrospective & prospective study done between 2009 to 2018. The diagnosis of infective endocarditis was done as per the modified Duke’s Criteria. 355 patients were analysed and baseline demographic data with echocardiographic, microbiologic,complications, treatment & outcomes noted. All blood cultures processing was done with BACTEC and BacTAlert using standard precautions.Antibiotic stewardship program was initiated since February 2016 as per international protocol. Results: The mean age of the study population was 46.7+-3 years. Predominanlty streptococcus species ( 21.4%) was isolated in the culture.A definite rise in atypical (17.9%) organism was noted in 2018 over the period of study as compared to 2009 : Presence of Burkholderia, Candida, Atypical Mycobacterium spp increased. Despite the advances in diagnostic modalities,there has been no change in mortality associated with IE (10.3%) over the period of 2009-2018. There is a predominantly native Mitral Valve involvement (53.7%) & a definite rise in Prosthetic Valve endocarditis (19.6%) noted in the last 5 years. Conclusion:This study is the largest study & data on Infective Endocarditis so far from a single centre in a developing world with a study population of 355 patients. Risk factors for IE have changed over time.Newer paradigms in treating IE and integration of antibiotic stewardship program has successfully brought down the cost and increased care in this part of the developing world. Changing trends : Organism Profile in IE Year Strept(%) Staph(%) Entero(%) Atypical(%) 2009 26.2 2.4 7.1 7.1 2011 24 8 12 16 2013 20 10 10 17.5 2015 27.3 12.7 3.6 20 2016 13.6 31.8 4.5 18.2 2017 27.6 13.8 10.3 34.5 2018 21.4 17.9 10.7 17.9 Abstract P265 Figure. Changing Epidemiological trends in IE