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Infective endocarditis in a racially mixed community: a 10 year review of 78 cases
Abstract:
Over a 10 year period, 78 cases of infective endocarditis were seen at a general hospital serving a multiracial community. There was a bimodal distribution by age and by race. Rheumatic heart disease was a predisposing factor in 45% of cases and was particularly common in young Polynesians. Only eight patients had undergone procedures which might have caused bacteraemia. Most cases were due to streptococci (67%) or staphylococci (27%). Eighteen of 78 patients (23%) died in hospital, usually as a result of overwhelming sepsis or neurological complications. The 60 discharged have been followed for an average of almost three years. There have been 11 deaths but only two related to the previous endocarditis. Three of 41 patients infected with viridans streptococci died. There were no relapses and only one microbiological failure due to these organisms. All 14 patients with viridans streptococcal endocarditis treated with combined therapy for two weeks were cured. Ten of 16 cases of Staph aureus endocarditis were fatal. All but one involved the left side of the heart. The series included no intravenous drug abusers. Sixteen cases of endocarditis involved prosthetic valves and in this group the mortality, frequency of complications and need for surgery were significantly more frequent than in those with native valve infection.
Insights
Infective endocarditis affects diverse populations, with streptococci and staphylococci as common causes. Rheumatic heart disease is a key risk factor, particularly in younger individuals.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Infective endocarditis (IE) is a serious infection of the heart lining.
- Understanding IE epidemiology and risk factors is crucial for effective management.
Purpose of the Study:
- To analyze the clinical features, predisposing factors, causative organisms, and outcomes of infective endocarditis.
- To investigate differences in IE presentation and outcomes based on valve type (native vs. prosthetic) and causative pathogens.
Main Methods:
- Retrospective case series of 78 infective endocarditis patients over 10 years.
- Data collection included patient demographics, predisposing conditions, microbiology, treatment, and outcomes (in-hospital and follow-up).
Main Results:
- IE showed bimodal age and racial distribution. Rheumatic heart disease was a significant predisposing factor (45%), especially in young Polynesians.
- Streptococci (67%) and Staphylococci (27%) were the most common pathogens. Mortality was 23% in-hospital, with sepsis and neurological complications being leading causes.
- Prosthetic valve endocarditis had higher mortality, complications, and surgical rates compared to native valve endocarditis. Viridans streptococcal IE had a better prognosis, especially with combined therapy.
Conclusions:
- Infective endocarditis presents diverse epidemiological patterns and risk factors, including rheumatic heart disease.
- Outcomes vary significantly based on causative organisms and valve involvement, highlighting the importance of targeted treatment strategies.
- Prosthetic valve endocarditis poses a greater challenge, necessitating vigilant monitoring and management.
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