Active infective endocarditis observed in an Indian hospital 1981-1991

Rajib Choudhury, Anil Grover, Jagmohan Varma, Hari N. Khattri, Inder S. Anand, Padmakar S. Bidwai, Purshottam L. Wahl, Rajendra P. Sapru

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60 Scopus citations

Abstract

Clinical data from 186 patients (133 males and 53 females) with 190 episodes of infective endocarditis (IE) occurring between January 1981 and July 1991 were studied retrospectively at a large referral hospital in Northern India with the intention of highlighting certain essential differences from those reported in the West. The mean age was much lower (25 ± SD 12 years, range 2 to 75 years). Rheumatic heart disease was the most frequent underlying heart lesion accounting for 79 patients (42%). This was followed by congenital heart disease in 62 (33%) and normal valve endocarditis in 17 (9%). Twenty-four patients had either aortic regurgitation (n = 15) or mitral regurgitation (n = 9) of uncertain etiology. Prosthetic valve infection and mitral valve prolapse were present in only 2 patients each. A definite predisposing factor could be identified in only 28 patients (15%). Postabortal sepsis and sepsis related to childbirth accounted for 6 and 5 cases, respectively. Only 1 patient had history of intravenous drug abuse. Two-dimensional echocardiography showed vegetations in 121 patients (64%). Blood cultures were positive in only 87 (47%), with a total of 90 microbial isolates. Commonest infecting organisms were staphylococci (37 cases) and streptococci (34 cases). Except for a significantly higher number of patients with neurologic complications in the culture-negative group, there were no differences between patients with culture-positive and culture-negative IE. Of the 190 episodes of IE, the patients had received antibiotics before admission in 110 (58%) instances. A significantly greater number of culture-negative patients had received antibiotics than did culture-positive patients (87 vs 23, p < 0.001). Overall in-hospital mortality was 25%. There was a significantly higher number of neurologic complications in patients who died than in those who recovered (38 vs 14%, p < 0.01). It is concluded that the spectrum of patients with IE that is seen is quite different from that seen in the West. Control of rheumatic fever on a national level, maintaining aseptic techniques during procedures related to childbirth including prophylactic antibiotics, and wider availability of sophisticated surgical techniques would go a long way in improving the outlook in these patients.

Original languageEnglish (US)
Pages (from-to)1453-1458
Number of pages6
JournalThe American Journal of Cardiology
Volume70
Issue number18
DOIs
StatePublished - Dec 1 1992

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