Clinical Spectrum of Infective Endocarditis in a Tertiary Care Centre in Western India: A Prospective Study

OBJECTIVES: We examined the microbiological spectrum, clinical profile, echocardiographic features and in-hospital outcomes of patients with definitive IE. METHODS: A total of 75 consecutive cases of definitive infective endocarditis (IE), admitted between January 2011 and January 2013, were included in the study. This was a prospective study enrolling all the consecutive definitive cases of IE admitted at U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India. Only the patients who met the modified Duke’s definitive criteria for IE were included in the study. We compared enrolled patients clinicoepidemiologic features and outcomes to subjects in the west. RESULTS: The mean age was 27.46 ± 17.11 years with a male preponderance (2.26:1). The rheumatic heart disease (41.3%) was the commonest underlying disease followed by coronary heart disease (34.7%). The blood culture was positive in 40% of episodes with commonest organisms being staphylococci (16%) and streptococci (12%). Complications were cardiovascular in 40 (53.3%) cases (congestive heart failure in 42.7%, atrioventricular block in 6.7%), septic shock in 20 (26.7%), neurological in 23 (30.7%) (cerebrovascular stroke in 20%, central nervous system hemorrhage in 5.3%, encephalopathy in 5.3%) and renal failure in 20 (26.7%) of cases respectively. Only 12 (16%) patients underwent surgery for IE. The total in hospital mortality rate was 22 (29.3%). On multivariate analysis, congestive heart failure, renal failure, neurological abnormalities, age < 20 years and septic shock were independent predictors of mortality. CONCLUSIONS: The spectrum of infective endocarditis is different in Indian population compared to the west and carries a substantial morbidity and mortality. The rheumatic heart disease is still the commonest underlying heart disease in our population. The culture positivity rates and surgery for infective endocarditis are unacceptably low. Early cardiac surgery may help to improve the outcomes of these patients.