Infective endocarditis in an Indian setup: Are we entering the ‘modern’ era?

BACKGROUND: The clinical profile of infective endocarditis (IE) has been continuously evolving over last 3-4 decades as highlighted by many studies from developed world. OBJECTIVES: To evaluate the recent changes in the spectrum and clinical profile, and outcome of IE in an Indian setup. MATERIALS AND METHODS: This was a descriptive, cross-sectional study. Demographic, clinical, characteristics, treatment, and outcome were examined in ‘definite’ cases of IE admitted at our institute between July 2005 and December 2010. RESULTS: 61 ‘definite’ cases were identified. Mean patient age was 49.3 ± 13.7 years. Male to female ratio was 3.3:1. Rheumatic heart disease was the underlying heart disease in 23 (37.7%) patients. 33 (54.1%) patients had already received antibiotic therapy before presentation to us. Blood cultures were positive in 41 (67.2%) patients. Streptococci and staphylococci were the commonest microbial isolates, 9 (21.4%) patients each. Transesophageal echocardiography (TEE) was done for all the patients. Vegetations were detected in 54 (88%) patients. Surgery was done in 30 (49.2%) patients. In-hospital mortality happened in 4 (6.5%) patients. CONCLUSIONS: We recorded several new trends, like: 1) an increasing age, 2) an increasing proportion of patients with no previously known heart disease, 3) improving culture positivity rates, 4) rise in staphylococcal infections, 5) increased usage of TEE, 6) high elective surgical rate, and 7) apparent improved survival rates. These changes point to the fact that ‘modern era’ changes in the profile of IE have started to appear in a selected population in India.