Infective Endocarditis in Sawanpracharak Hospital

Abstract

Objectives         :   To study the clinical characteristic, causative organisms, in-hospital mortality rate and factors associated with in-hospital patients with infective endocarditis(IE).

Method            :   Retrospective descriptive study has been done in patients with infective endocarditis (by diagnostic modified Duck criteria) who were admitted in Sawanpracharak Hospital during October 1,2010 to September 30, 2020.  Data collected by reviewing patient medical records including age, gender, comorbidities, clinical manifestations, complication, echocardiogram results, blood cultures and treatment results.

Results             :   128 IE patients 60.9% was definite IE and 39.1% was passible IE. Median age was 48 years(range 16-80)  and 71.1% was male.  Rheumatic heart disease was a major predisposing heart condition(36.5%), whereas the common clinical manifestations were fever(97.7%), cardiac murmur(86.7%) and dyspnea (57%). The common complications were heart failure or cardiogenic shock(21%), renal failure(15.6%) and septic shock(10.2%). Most of the patients were infected with native valve(94.2%). The most common sites  of vegetation were mitral valve(45.8%)  and aortic valve(42.5%). The result of positive  blood culture was 71.9% - Streptococcus suis(18.5%) and viridans  group streptococci(15.2%) were the most common pathogens. Significantly, factors increased mortality rate of in-patients  were septic shock (ORadj = 6.96; 95% CI 1.95-24.82, P<0.01) and heart failure(ORadj = 4.31 ; 95% CI  1.50-12.39, P= 0.01)

Conclusion        :   Most cases of infective endocarditis were presented in young people and rheumatic heart disease remaining the most common underlying pathology. The incidence of Streptococcus suis increased. The mortality rate of in-patient was still high , especially in cases with severe complications – septic shock and heart failure or cardiogenic shock.