The aim of the study was to describe the epidemiological and clinical aspects of native
valve infective endocarditis (IE) in a Tunisian high-volume tertiary care center and
to identify the predictors of outcome. Demographic, clinical, laboratory, and echocardiographic
characteristics were examined in 134 patients who fulfilled the modified Duke criteria
for native valve IE between January 1997 and December 2006. Logistic regression analysis
was used to identify prognostic factors for death. Mean age was 34.22 years. Diagnosis
was definite in 93% of cases. Median time to diagnosis was 21 days. Rheumatic heart
disease (RHD) was the predominant (45%) underlying heart condition. One or more vegetations
were detected in more than 93% of cases. The median size of vegetation was >15 mm
in 28% of cases. In 66 cases (49%), cultures remained negative. Serology was positive
in 15 cases, and in 4 cases leaflet culture identified the agent. The infective agent
was identified in 87 cases (65%), causative microorganisms were mainly Staphylococci (n = 30, including 6 coagulase-negative Staphylococcus), and Streptococci (n = 32). Overall mortality was 19%. On multivariate analysis, congestive heart failure
(hazard ratio = 5.34, 95% confidence interval 1.67 to 17.15, p = 0.005) and large
vegetations (>15 mm; hazard ratio = 5.78, 95% confidence interval 1.84 to 18.32, p
= 0.002) were predictive of in-hospital mortality but not neurological complications
or staphylococcus IE. In conclusion, IE remains a serious disease affecting a young
population in Tunisia, with RHD as still the most common underlying heart disease,
and it is associated with a high mortality.
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Article info
Publication history
Published online: September 09, 2008
Accepted:
June 20,
2008
Received in revised form:
June 20,
2008
Received:
May 20,
2008
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
