Infective endocarditis in Tunisia: Current epidemiology, clinical spectrum and outcome. A ten-year retrospective study

Background Despite great medical progress, infective endocarditis (IE) remains a serious infection with a high frequency and a poor prognosis. Since its first description, the profile of the disease has evolved continuously. Nevertheless, epidemiological features are different in developing countries compared with western countries. Purposes To describe the epidemiological, clinical, bacteriological and echocardiographic characteristics of IE in our hospital and its outcome. Methods We conducted a retrospective study between 2008 and 2018 in our department. We included patients with definite IE according to the modified Duke criteria. Results Seventy-five patients were included; forty-seven were male, with a sex ratio of 1.67. The mean age was 51 ± 18 years. Degenerative and rheumatic valve diseases (32% and 29% respectively) were the two main underlying heart diseases. IE occurred on prosthetic valves in 20% of cases. The iatrogenic portal of entry was the most frequently observed (42.7%). Microbiological findings identified Staphylococcus aureus (18.7%), Streptococcus (8%) and Gram-negative bacilli (5.3%) while blood cultures were negative in68% of cases. Echocardiography showed: vegetations (76%), mutilations (16%), abscesses (13.3%), and disinsertion or obstruction of prosthesis (13.3%). The complications were observed in54.7% of cases ( Table 1 ). Fifty-two patients (69.3%) were operated on. An emergency surgery was needed in 28% of these cases. The overall mortality was 24%. The statistical analysis concluded that the location of endocarditis on mitral prosthesis (P = 0.01), the persistent fever (P = 0.003) and the duration of antibiotic therapy (P = 0.002) were independent risk factors for mortality (table 1). Conclusion The epidemiological features of IE in our country are increasingly close to that of western countries. This is due to better preventive, diagnostic and therapeutic tools. However, the incidence of IE remains stable and its prognosis remains poor.