Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India

Objective: Several studies have demonstrated a shift in the spectrum of infective endocarditis (IE) in the developed world. We aimed to investigate whether demographic and microbiologic characteristics of IE have changed in India. Design: A retrospective analysis of patients with in north India betw...

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Autores principales:	Navneet Arora, Prashant Kumar Panda, Pruthvi CR, Lipi Uppal, Atul Saroch, Archana Angrup, Navneet Sharma, Yash Paul Sharma, Rajesh Vijayvergiya, Manoj Kumar Rohit, Ankur Gupta, Bhupinder Kumar Sihag, Himanshu Gupta, Neelam Dahiya, Ajay Bahl, Parminder Singh, Saurabh Mehrotra, Parag Barwad, Ashok Kumar Pannu
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Endocarditis Epidemiology Injection drug use Rheumatic heart disease Staphylococcus Echocardiography Surgery RD1-811 Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/03533de0dfd343c1aef5233e56f6232b
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spelling	oai:doaj.org-article:03533de0dfd343c1aef5233e56f6232b2021-12-02T04:57:59ZChanging spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India0019-483210.1016/j.ihj.2021.09.008https://doaj.org/article/03533de0dfd343c1aef5233e56f6232b2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S0019483221001954https://doaj.org/toc/0019-4832Objective: Several studies have demonstrated a shift in the spectrum of infective endocarditis (IE) in the developed world. We aimed to investigate whether demographic and microbiologic characteristics of IE have changed in India. Design: A retrospective analysis of patients with in north India between 2010 and 2020. Methods: The clinical and laboratory profiles of 199 IE admitted to an academic hospital patients who met the modified Duke criteria for definite IE were analysed. Results: The mean age was 34 years, and 84% were males. The main predisposing conditions were injection drug use (IDU) (n = 71, 35.7%), congenital heart disease (n = 46, 21.6%), rheumatic heart disease (n = 25, 12.5%), and prosthetic device (n = 19, 9.5%). 17.1% of patients developed IE without identified predispositions. Among 64.3% culture-positive cases, the most prevalent causative pathogens were Staphylococcus aureus (46.1%), viridans streptococci (7.0%), enterococci (6.0%), coagulase-negative staphylococci (5.5%), gram negative bacilli (5.5%), polymicrobial (5.5%), and Candida (1.0%). The tricuspid (30.3%), mitral (25.6%), and aortic (21.6%) valves were the most common sites of infection, and 60.3% had large vegetations (>10 mm). Systemic embolization occurred in 55.3% of patients at presentation. Cardiac surgery was required for 13.1%. In-hospital mortality was 17.1% and was associated with prosthetic devices (p-value, 0.001), baseline leucocytosis (p-value, 0.036) or acute kidney injury (p-value, 0.001), and a microbial etiology of gram negative bacilli or enterococci (p-value, 0.005). Conclusion: IDU is now the most important predisposition for IE in India, and S. aureus has become the leading cause of native valve endocarditis with or without IDU.Navneet AroraPrashant Kumar PandaPruthvi CRLipi UppalAtul SarochArchana AngrupNavneet SharmaYash Paul SharmaRajesh VijayvergiyaManoj Kumar RohitAnkur GuptaBhupinder Kumar SihagHimanshu GuptaNeelam DahiyaAjay BahlParminder SinghSaurabh MehrotraParag BarwadAshok Kumar PannuElsevierarticleEndocarditisEpidemiologyInjection drug useRheumatic heart diseaseStaphylococcusEchocardiographySurgeryRD1-811Diseases of the circulatory (Cardiovascular) systemRC666-701ENIndian Heart Journal, Vol 73, Iss 6, Pp 711-717 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Endocarditis Epidemiology Injection drug use Rheumatic heart disease Staphylococcus Echocardiography Surgery RD1-811 Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Endocarditis Epidemiology Injection drug use Rheumatic heart disease Staphylococcus Echocardiography Surgery RD1-811 Diseases of the circulatory (Cardiovascular) system RC666-701 Navneet Arora Prashant Kumar Panda Pruthvi CR Lipi Uppal Atul Saroch Archana Angrup Navneet Sharma Yash Paul Sharma Rajesh Vijayvergiya Manoj Kumar Rohit Ankur Gupta Bhupinder Kumar Sihag Himanshu Gupta Neelam Dahiya Ajay Bahl Parminder Singh Saurabh Mehrotra Parag Barwad Ashok Kumar Pannu Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India
description	Objective: Several studies have demonstrated a shift in the spectrum of infective endocarditis (IE) in the developed world. We aimed to investigate whether demographic and microbiologic characteristics of IE have changed in India. Design: A retrospective analysis of patients with in north India between 2010 and 2020. Methods: The clinical and laboratory profiles of 199 IE admitted to an academic hospital patients who met the modified Duke criteria for definite IE were analysed. Results: The mean age was 34 years, and 84% were males. The main predisposing conditions were injection drug use (IDU) (n = 71, 35.7%), congenital heart disease (n = 46, 21.6%), rheumatic heart disease (n = 25, 12.5%), and prosthetic device (n = 19, 9.5%). 17.1% of patients developed IE without identified predispositions. Among 64.3% culture-positive cases, the most prevalent causative pathogens were Staphylococcus aureus (46.1%), viridans streptococci (7.0%), enterococci (6.0%), coagulase-negative staphylococci (5.5%), gram negative bacilli (5.5%), polymicrobial (5.5%), and Candida (1.0%). The tricuspid (30.3%), mitral (25.6%), and aortic (21.6%) valves were the most common sites of infection, and 60.3% had large vegetations (>10 mm). Systemic embolization occurred in 55.3% of patients at presentation. Cardiac surgery was required for 13.1%. In-hospital mortality was 17.1% and was associated with prosthetic devices (p-value, 0.001), baseline leucocytosis (p-value, 0.036) or acute kidney injury (p-value, 0.001), and a microbial etiology of gram negative bacilli or enterococci (p-value, 0.005). Conclusion: IDU is now the most important predisposition for IE in India, and S. aureus has become the leading cause of native valve endocarditis with or without IDU.
format	article
author	Navneet Arora Prashant Kumar Panda Pruthvi CR Lipi Uppal Atul Saroch Archana Angrup Navneet Sharma Yash Paul Sharma Rajesh Vijayvergiya Manoj Kumar Rohit Ankur Gupta Bhupinder Kumar Sihag Himanshu Gupta Neelam Dahiya Ajay Bahl Parminder Singh Saurabh Mehrotra Parag Barwad Ashok Kumar Pannu
author_facet	Navneet Arora Prashant Kumar Panda Pruthvi CR Lipi Uppal Atul Saroch Archana Angrup Navneet Sharma Yash Paul Sharma Rajesh Vijayvergiya Manoj Kumar Rohit Ankur Gupta Bhupinder Kumar Sihag Himanshu Gupta Neelam Dahiya Ajay Bahl Parminder Singh Saurabh Mehrotra Parag Barwad Ashok Kumar Pannu
author_sort	Navneet Arora
title	Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India
title_short	Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India
title_full	Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India
title_fullStr	Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India
title_full_unstemmed	Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India
title_sort	changing spectrum of infective endocarditis in india: an 11-year experience from an academic hospital in north india
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/03533de0dfd343c1aef5233e56f6232b
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Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India

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