Research Article
Descriptive Epidemiological, Clinical and Microbiological Features of Infective Endocarditis in Saudi Arabia
Mohamed Nabil Alama*
Department of Medicine, Faculty of Medicine, King Abdulaziz Hospital, King Abdulaziz University, Jeddah 21589,
Saudi Arabia
*Corresponding author: Mohamed Nabil Alama, Department of Medicine, Faculty of Medicine, King Abdulaziz Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia
Published: 20 Sep, 2017
Cite this article as: Alama MN. Descriptive Epidemiological,
Clinical and Microbiological Features of
Infective Endocarditis in Saudi Arabia.
Clin Surg. 2017; 2: 1626.
Abstract
Objective: The present study describes the microbiological, clinical, echocardiographic and
complications of infective endocarditis (IE) at the King Abdulaziz University Hospital (KAUH),
Jeddah, Saudi Arabia. Retrospective epidemiological study from year 2016 to 2017 for all patient
whereas diagnosis with infective endocarditis. The inclusion criteria any patient diagnosed with IE
among adult patient and the exclusion criteria pediatric patient. Data was collected demographic,
clinical and microbiology information and all data were entered to SPSS version 21 considering
patient confidentiality. Continuous variables were compared with the Mann–Whithney U test and
categorical variables with the x2 test or Fisher’s exact test. In order to assess linearity, the quadratic
age effect has been introduced in the model. The total number of patient diagnosed with IE was 28
cases, the average age is 48 (±18) years old, IE most common in male gender 21 (75%) compared to
female 7 (25%), prevalence of disease higher among non-Saudi 21 (75%) compared to Saudi 7 (25).
The patient clinical classification were acute (53%) phase are more frequent than sub-acute (48),
moreover those underwent medical treatment are (93%) compared to surgical treatment. All the
differences were statically almost significant (P = 0.06).
Conclusion, my results demonstrate the epidemiological, microbiological and clinical profiles of IE
in a tertiary hospital in Jeddah, Saudi Arabia. The highest risk factors were surgical intervention and
heart disease and lower among patient with prosthetic heart valve.
Keywords: Microbiological features; Epidemiology; Infective endocarditis; Saudi Arabia
Introduction
Infective Endocarditis (IE) is a microbial infection of heart valves and its endothelial lining
which is considered as a life-threatening disorder [1-4]. Although the IE rate was low, the disease
was still dangerous due to of hard diagnosis and treatment with high mortality. The occurrence of
IE varied greatly. In countries with high industries, and higher degenerative heart disease a low
rheumatic heart disease have resulted in aging patient, and high incidence of infections of Staph.
Aureus, which is transmitted basically from healthcare [5-7]. The identification rate of the causing
agents in the developed countries is recorded to be very high, while it is lower in the developing
countries [8-12]. IE has different etiological factors, manifestations clinically, and treatment course
in different gender and ages. In study carried out [13-15] on S. aureus, which has become the main
causes in the developed world, leading to sever type of the disease in aged patient. Diagnosis and
treatment of IE is still a challenge for physicians. Group of patients with the worst prognosis is
treated by cardiologist and infectious diseases physician etiologic agent cannot be identified in a
substantial number of patients. There is lacking information about the prevalence of IE &causes
from Saudi Arabia, So, the present study describes the microbiological, clinical, echocardiographic
and complications of infective endocarditis (IE) at the KAUH hospital, Jeddah, Saudi Arabia.
Setting
KAUH is tertiary and teaching hospital affiliated to medical school in Jeddah city at Saudi
Arabia. The bed capacity 750 which including all services total number of discharge patient per year
was 45,182 Patients.
Methodology
Retrospective epidemiological study from year 2016 to 2017 for all patient whereas diagnosis with infective endocarditis. The inclusion criteria any patient diagnosed with IE among adult patient and the exclusion criteria pediatric patient. Data was collected demographic, clinical and microbiology information all data were entered to SPSS version 21 considering patient confidentiality. Continuous variables were compared with the Mann-Whitney U test and categorical variables with the x2 test or Fisher’s exact test. In order to assess linearity, the quadratic age effect has been introduced in the model, and it was not found statistically significant.
Table 1
Table 2
Table 3
Table 4
Table 5
Table 6
Results
The total number of patient diagnosed with IE was 28 cases, the average age is 48 (±18) years old, IE most common in male gender 21 (75%) compared to female 7 (25%), prevalence of disease higher among non-Saudi 21 (75%) compared to Saudi 7 (25). The patient clinical classification were acute (53%) phase are more frequent than sub-acute (48), moreover those underwent medical treatment are (93%) compared to surgical treatment (Table 1). All the differences were statically almost significant (P = 0.06). Table 2 shows patient diagnosed IE with Co-morbidity the HTN and DM are common (12 and 11) respectively however these differences statistically significant (P= 0.05). Sign and symptom were shown in table 3 that anorexia (55%) followed by weightless (50%), shortness of breath (48%) were common among IE patient and these differences were statistically significant. Table 4 present the most common organism caused IE were Staphylococcus arues (40%) followed by Streptococcus viridians (30%). The risk factor associated IE presented in table 5 those cases under went TTE procedures (88%) followed surgical intervention (28%) where high risk to have IE compared to other factor, these differences was statistically significant. Table 5 shows the complication affected patient with IE were valve dysfunction (83%) followed by vegetation (55%). Table 6 shows the laboratory result that patient with IE has high CRP (70%) and high ESR (65%).
Discussion
IE means surface infection of cardiac endothelium suggesting
physical presence of microorganisms in the lesion and heart infection.
IE is a serious and life-threatening condition, which may lead to death if untreated. Today, despite the medical and technological
advancements in the field of pharmaceutical therapies of microbial
infections and advanced surgical procedures, the mortality rate
related to IE has not decreased. This disease is more dominant in
intravenous addicts and cardiovascular patients, specifically heart
valve replacement patients [16]. Despite its rare occurrence, infective
endocarditis (IE). In the general population, IE is generally low
and uncommon disease associated with significant morbidity and
mortality and appears to vary greatly among different populations
even within the same country. Its incidence in the present. Multiple
factors could have led to variability in IE incidence, including referral
and case ascertainment biases, disease misclassification, differences in
populations at risk, study designs, and use of different case definitions.
IE is an uncommon disorder that was almost universally fatal in the
preantibiotic era, and remains a major clinical problem today, despite
advances in medical and surgical treatments study on Infective
endocarditis: Clinical features and prognosis in a non-teaching
hospital and results showed IE remains a severe disease and S. aureus
is more often involved... In one study conducted in Italy found the
incidence rate of IE is 4.6/100,000/y [17]. In the present study, the
highest risk factors were surgical intervention and heart disease and
lower among patient with prosthetic heart valve (10%) our finding
similar to one study focused on surgical intervention as risk factors
and establish scoring system for those patients the predominant
complication affected patient with IE were valve dysfunction (83%)
followed by vegetation (55%). Moreillon and Murdoch reported that
CHF has the most serious effect on prognosis of IE. Microorganism
isolated from IE patients was S. aureus accounting for 42 % of all the
infections, followed by streptococcus viridians, other streptococcus,
cogalse negative Staphylococcus and Enterococcus. These results were
in agreement with [18,19]. In this study showed the male are higher
compared the female gender, the mean age of patients with IE has
increased the average age among cases Male was 50 (±16) and Female
43 (±12), numerous studies showed the IE are common among
elderly and recent studies of IE in Turkey have found it to be between
45 and 51 years [20-22]. Other predisposing conditions for IE, such
as the presence of Prosthetic heart valve, Structure heart disease,
Noncompliance dental hygiene, surgical intervention. Previous
diagnosis IE, Hospital acquired infection were the same as identified
in other studies. The non-Saudi cases more frequent than Saudi the
reason most of KAUH population from other nationality because
we are only governmental hospital accepting other nationality. The
chronic diseases associated with IE are 12% of cases were having
IHD, 12% have hypertension and 11% have diabetes mellitus. Sign
and symptoms associated with IE as the following chills, malasia,
anorexia, and weight loss, and arthralgia, shortness of breath, cough,
chest and back pain. Around 55% of our patient had anorexia and
50% weight loss only 10% complained from arthralgia [23].
Conclusion, my results demonstrate the epidemiological,
microbiological and clinical profiles of IE in a tertiary hospital
in Jeddah, Saudi Arabia. The highest risk factors were surgical
intervention and heart disease and lower among patient with
prosthetic heart valve.
References
- Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001;345(18):1318-30.
- Ben-Ami R, Giladi M, Carmeli Y, Orni-Wasserlauf R, Siegman-Igra Y. Hospital-acquired infective endocarditis: should the definition be broadened? Clin Infect Dis. 2004;38(6):843-50.
- Moreillon P, Que YA. Infective endocarditis. Lancet. 2004;363(9403):139-49.
- Demirbağ R, Sade LE, Aydın M, Bozkurt A, Acartürk E. The Turkish registry of heart valve disease. Turk Kardiyol Dern Ars. 2013;41(1):1-10.
- Murdoch DR, Corey GR, Hoen B, Miro´ JM, Fowler Jr VG, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century. The International Collaboration on Endocarditis–Prospective Cohort Study. Arch Intern Med. 2009;169(5):463-73.
- Lomas JM, Martinez-Marcos J, Palata A, Ivanova R, Ga´ lvez J, Ruiz J, et al. Healthcare-associated infective endocarditis: an undesirable effect of health-care universalization. Clin Microbiol Infect. 2010;16(11):1683-90.
- Selton-Suty C, Célard M, Le Moing V, Doco-Lecompte T, Chirouze C, Iung B, et al. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis. 2012;54(9):1230-9.
- Tariq M, Alam M, Munir G, Khan MA, Smego RA Jr. Infective endocarditis: a five-year experience at a tertiary care hospital in Pakistan. Int J Infect Dis. 2004;8(3):163-70.
- Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P, et al. Characteristics of infective endocarditis in a developing country—clinical profile and outcome in 192 Indian patients, 1992–2001. Int J Cardiol. 2005;98(2):253-60.
- Letaief A, Boughzala E, Kaabia N, Ernez S, Abid F, Ben Chaabane T, et al. Epidemiology of infective endocarditis in Tunisia: a 10-year multicenter retrospective study. Int J Infect Dis. 2007;11(5):430-3.
- Nunes MC, Gelape CL, Ferrari TC. Profile of infective endocarditis at a tertiary care center in Brazil during a seven-year period: prognostic factors and in-hospital outcome. Int J Infect Dis. 2010;14(5):e394-8.
- Math RS, Sharma G, Kothari SS, Kalaivani M, Saxena A, Kumar AS, et al. Prospective study of infective endocarditis from a developing country. Am Heart J. 2011;162(4):633-8.
- Gouëllo JP, Asfar P, Brenet O, Kouatchet A, Berthelot G, Alquier P. Nosocomial endocarditis in the intensive care unit: an analysis of 22 cases. Crit Care Med. 2000;28(2):377-82.
- Benslimani A, Fenollar F, Lepidi H, Raoult D. Bacterial zoonoses and infective endocarditis, Algeria. Emerg Infect Dis. 2005;11(2):216-24.
- Sucu M, Davutoğlu V, Ozer O, Aksoy M. Epidemiological, clinical and microbio-logical profile of infective endocarditis in a tertiary hospital in the South-East Anatolia Region. Arch Turk Soc Cardiol. 2010;38(2):107-11.
- Duval X, Delahaye F, Alla F, Tattevin P, Obadia JF, Le Moing V, et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol. 2012;59(22):1968-76.
- Leone S, Ravasio V, Durante-Mangoni E, Crapis M, Carosi G, Scotton PG, et al. Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis. Infection. 2012;40(5):527-35.
- Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. 2005;293(24):3012-21.
- Chirouze C, Athan E, Alla F, Chu VH, Ralph Corey G, Selton-Suty C, et al. Enterococcal endocarditis in the beginning of the 21st century: analysis from the International Collaboration on Endocarditis Prospective Cohort Study. Clin Microbiol Infect. 2013;19(12):1140-7.
- Leblebicioglu H, Yilmaz H, Tasova Y, Alp E, Saba R, Caylan R, et al. Characteristics and analysis of risk factors for mortality in infective endocarditis. Eur J Epidemiol. 2006;21(1):2531.
- Tugcu A, Yildirimturk O, Baytaroglu C, Kurtoglu H, Ko¨ se O, Sener M, et al. Clinical spectrum, presentation and risk factors for mortality in infective endocarditis: a review of 68 cases at a tertiary care center in Turkey. Arch Turk Soc Cardiol. 2009;37(1):9-18.
- Elbey MA, Akdağ S, Kalkan ME, Kaya MG, Sayın MR, Karapınar H, et al. A multicenter study on experience of 13 tertiary hospitals in Turkey in patients with infective endocarditis. Anadolu Kardiyol Derg. 2013;13(6):523-7.
- Hoen B, Duval X. Clinical practice. Infective endocarditis. N Engl J Med. 2013;368(15):1425-33.