Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India

Indian Heart J. Nov-Dec 2021;73(6):711-717. doi: 10.1016/j.ihj.2021.09.008. Epub 2021 Sep 16.

Abstract

Objective: Several studies have demonstrated a shift in the spectrum of infective endocarditis (IE) in the developed world. We aimed to investigate whether demographic and microbiologic characteristics of IE have changed in India.

Design: A retrospective analysis of patients with in north India between 2010 and 2020.

Methods: The clinical and laboratory profiles of 199 IE admitted to an academic hospital patients who met the modified Duke criteria for definite IE were analysed.

Results: The mean age was 34 years, and 84% were males. The main predisposing conditions were injection drug use (IDU) (n = 71, 35.7%), congenital heart disease (n = 46, 21.6%), rheumatic heart disease (n = 25, 12.5%), and prosthetic device (n = 19, 9.5%). 17.1% of patients developed IE without identified predispositions. Among 64.3% culture-positive cases, the most prevalent causative pathogens were Staphylococcus aureus (46.1%), viridans streptococci (7.0%), enterococci (6.0%), coagulase-negative staphylococci (5.5%), gram negative bacilli (5.5%), polymicrobial (5.5%), and Candida (1.0%). The tricuspid (30.3%), mitral (25.6%), and aortic (21.6%) valves were the most common sites of infection, and 60.3% had large vegetations (>10 mm). Systemic embolization occurred in 55.3% of patients at presentation. Cardiac surgery was required for 13.1%. In-hospital mortality was 17.1% and was associated with prosthetic devices (p-value, 0.001), baseline leucocytosis (p-value, 0.036) or acute kidney injury (p-value, 0.001), and a microbial etiology of gram negative bacilli or enterococci (p-value, 0.005).

Conclusion: IDU is now the most important predisposition for IE in India, and S. aureus has become the leading cause of native valve endocarditis with or without IDU.

Keywords: Echocardiography; Endocarditis; Epidemiology; Injection drug use; Rheumatic heart disease; Staphylococcus.

MeSH terms

  • Adult
  • Endocarditis* / diagnosis
  • Endocarditis* / epidemiology
  • Endocarditis* / etiology
  • Endocarditis, Bacterial* / diagnosis
  • Endocarditis, Bacterial* / epidemiology
  • Hospitals
  • Humans
  • Male
  • Retrospective Studies
  • Staphylococcus aureus