Trends in infective endocarditis over two decades in a Thai tertiary care setting

Infective endocarditis (IE) is a serious condition with high morbidity and mortality. This retrospective cohort study evaluated the evolution of clinical characteristics, microbiological profiles, and treatment outcomes in 435 Thai IE patients, spanning three distinct periods, at a Chiang Mai tertiary-care hospital. Patients were categorized into three timeframes: 1998-2001 (n = 134), 2012-2015 (n = 117), and 2016-2020 (n = 184). The median patient age significantly increased from 42 years (IQR 34-51) to 58 years (IQR 44-65) (p = 0.003). The study also identified an increased prevalence of co-morbidities in recent years. Notably, there was a marked decrease in the prevalence of rheumatic heart disease, from 23.1 to 10.9% (p = 0.009). Streptococcus suis is a unique and increasingly prevalent cause of IE in northern Thailand. Additionally, the rate of culture-negative IE declined from 38.1 to 23.9% (p = 0.018). Surgical interventions increased from 52.2 to 64.1% (p = 0.072), while the median time to surgery remained constant at 12 days. Despite advancements in diagnosis and treatment, the length of hospitalization remained stable throughout the study periods, and the in-hospital mortality rate consistently stayed at 18.6%. This study highlights significant shifts in the epidemiology and management of IE, indicating persistent challenges in reducing mortality despite improved care.