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Infective endocarditis: report of a prospective study in an Indian hospital
B Khanal1, B N Harish, K R Sethuraman
1Department of Microbiology, BP Koirala Institute of Health Sciences, Dharan, Nepal. basudhak@hotmail.com
Insights
Infective endocarditis (IE) predominantly affects younger patients with rheumatic heart disease. Rising drug-resistant bacteria like MRSA complicate treatment, necessitating tailored antibiotic selection based on in vitro testing and clinical monitoring.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Understanding the demographics and etiological agents of IE is crucial for effective management.
Purpose of the Study:
- To evaluate the clinical characteristics and microbiological profile of infective endocarditis patients.
- To identify trends in causative organisms and antibiotic resistance.
Main Methods:
- Retrospective analysis of 46 patients meeting Duke's criteria for IE.
- Assessment of patient demographics, underlying cardiac conditions, and blood culture results.
- Evaluation of antibiotic susceptibility patterns.
Main Results:
- Most patients (76%) were under 40, with rheumatic heart disease being the most common underlying lesion (56%).
- Blood cultures were positive in 44%, with Streptococcus as the most frequent pathogen.
- Increasing incidence of Staphylococcus and Gram-negative bacillary endocarditis noted.
- Emergence of methicillin-resistant Staphylococcus aureus (MRSA) and high-level gentamicin-resistant Enterococcus.
Conclusions:
- Infective endocarditis presents a complex challenge, particularly with the rise of antibiotic-resistant organisms.
- Effective treatment requires careful antibiotic selection guided by in vitro susceptibility testing and clinical monitoring.
Abstract:
Forty-six patients who fulfilled the Duke's clinical diagnostic criteria for infective endocarditis (IE) were evaluated. Thirty-five (76%) patients were below 40 years of age with rheumatic heart disease being the most common underlying heart lesion affecting 26 (56%). An obvious predisposing cardiac lesion could not be ascertained in 22%. Blood culture positivity was 44% with streptococcus heading the list. The incidence of the staphylococcal (25%) and gram negative bacillary endocarditis (15%) were found to be increasing. Streptococci were susceptible to penicillin with minimum bactericidal concentration: minimum inhibitory concentration within acceptable limits. However, the appearance of methicillin resistant staphylococcus aureus and high level gentamicin resistant enterococcus as aetiological agents of infective endocarditis were found to add to the complexity of the problem. With the emergence of drug-resistant organisms as causative agents of IE, whenever medical therapy is the primary method of treatment of this condition, the selection of antibiotics should depend upon extensive in vitro testing and in vivo monitoring of clinical efficacy.