Changing trends of infective endocarditis

Objective: To determine the frequency of culture positive and culture negative endocarditis and type of organisms causing bacterial endocarditis in patients admitted at National Institute of Cardiovascular Diseases (NICVD), Karachi. Methods: This was a cross sectional, descriptive study conducted from 29th March 2006 to 13th October 2006 at National Institute of Cardiovascular Diseases, Karachi. All patients having clinical suspicion of infective endocarditis were admitted and worked up. Seventy five patients having definite infective endocarditis as per Duke Criteria were included. Results: There were 55 (70%) males and 20 (30%) females. Mean age of the patients was 23 +/- 8.9 years. Ninety percent of the patients were below 40 years of age. Six patients had prosthetic valve and six were intravenous drug abusers. The commonest signs and symptoms observed were fever, shortness of breath, weight loss, murmur, pallor and splenomegaly. Mitral valve was affected in majority of patients. Blood cultures were positive in 40 (53.3%) cases while 35 (46.7%) cases were culture negative. Nine (22.5%) patients out of 40 culture positive cases and 29(82.8%) patients out of 35 culture negative cases were using antibiotics before admission. All six intravenous drug abusers showed culture positive endocarditis. Among culture positive cases, staphylococcus group was found in 21 (52.5%) cases while streptococcus group in 11 (27.5%) cases. Coagulase negative staphylococci were found to be the most common organism, that is 14/40 (35%) patients. Conclusion: Changes in spectrum of organisms causing bacterial endocarditis reported by western researchers do exist in our community. To know the reason behind these changing trends needs further advanced studies and evaluation (JPMA 60:24; 2010).