Background: Infective endocarditis (IE) is a serious pathology which is in a continuum evolution in the setting of diagnosis and therapeutic fields
Aim: To describe clinical, echocardiographic, microbiological, therapeutic and outcome characteristics of infective endocarditis in a Tunisian population.
Methods: The records of 135 patients admitted to adult cardiology department of la Rabta hospital between January 1981 and December 2011 were collected. The diagnosis of certain IE was retained according to modified Duke Criteria.
Results: The mean age of patients was 38.5 ± 16 years, with a male predominance (sex ratio: 1.4). IE affected native valves in 77% of cases, prosthetic valve in 15.5% of cases, congenital heart disease in 2% and pacemaker in 1.48% of patients. The portal of entry was identified in 43.7% of the patients, the oral origin was predominant. Blood cultures were positive in only 34% of patients. Causative microorganism was staphylococcus in 43.6%, streptococcus in 43.6% and negative bacill gram in 17.4% of patients. Echocardiography showed vegetation in 98% of patients, cardiac abscess in 23.7% of patients and valve mutilation in 17.7% of cases. Prosthesis dehiscence was present in 4.5% of cases. Complications were primarily hemodynamic (57%) followed by embolic events (34%). Surgery occurred in 57.7% of patients, it was early in 69% of cases. The indication was mainly hemodynamic and mixed in 70%of patients. Hospital mortality was 28% with predictor's factors: left heart (p=0.02), prosthesis (p <0.05), staphylococcus (p<0.005), heart failure (p<0.05) and neurological complications (p=0.04).
Conclusion: According to our study, infective endocarditis has always touched a young population in Tunisia, rheumatic valve disease is still the predominant underlying heart disease and both streptococcus and staphylococcus are most frequently isolated. Mortality remains high despite considerable progress in terms of diagnosis and therapy.