[Retrospective study on 100 cases of infective endocarditis, Rabta University Hospital, Tunis, from 1980 to 2004]

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Diagnostics

Background:

• Infective endocarditis (IE) is a serious infection affecting heart valves.
• Underlying heart disease, particularly rheumatic heart disease, is a common predisposing factor in IE cases.
• Native valve endocarditis (NVE) is more prevalent than prosthetic valve endocarditis (PVE).

Purpose of the Study:

• To analyze trends and outcomes of infective endocarditis (IE) over a 24-year period.
• To evaluate the impact of introducing trans-esophageal echocardiography (TOE) on IE management and mortality.
• To identify predictors of mortality in patients with IE.

Main Methods:

• Retrospective analysis of 100 IE cases from 1980-2004, divided into pre-TOE (Group A) and post-TOE (Group B) periods.
• All patients underwent transthoracic echocardiography (TTE); Group B patients also had trans-esophageal echocardiography (TOE).
• Clinical data, microbiological findings, surgical interventions, and outcomes were reviewed.

Main Results:

• Mortality while awaiting surgery decreased significantly from 41.8% in Group A to 8.9% in Group B (p < 0.05), coinciding with TOE introduction.
• Staphylococcal infections (p < 0.05) and Gram-negative bacilli were identified in positive blood cultures.
• Predictors of mortality included positive staphylococcal blood cultures, valve mutilations, unstable prostheses, and heart failure. Overall mortality was 34%.

Conclusions:

• The introduction of trans-esophageal echocardiography (TOE) has significantly improved outcomes and reduced mortality in infective endocarditis (IE) management.
• Prompt surgical intervention remains crucial for a majority of IE patients.
• Early identification of risk factors like staphylococcal bacteremia and heart failure is vital for improving IE patient survival.