Infective Endocarditis in the Young, Risk Profile, Patient Demographics and Hospital Outcome during Hospital Stay. Registry among Ain Shams University Hospitals
Authors: KhalilLakah Teresa-Maria , Shabana Adel Mohamed , Abdallah Abdallah Ahmed 
Published: November 2024

Abstract

Background
Infective endocarditis (IEC) is a serious and potentially life-threatening condition if left untreated.

Objective
To identify demographics, risk profile and hospital outcome during hospital stay of young patients with infective endocarditis admitted to Ain Shams University Hospitals.

Patients and Methods
We developed a registry to describe patient demographics, risk factors, clinical features, and hospital outcomes for all cases of infective endocarditis diagnosed using modified Duke's criteria referred to Ain Shams University in Egypt over a six-month period.

Results
We collected 72 confirmed cases of infective endocarditis that presented to Ain Shams University hospitals over a six-month period (from August 2023 to January 2024). We observed that the mean age was 35 years [(87.5 %) males and (12.5%) females]. Among them, (70.8%) were smokers, (68.1%) were IV drug users. Three main substances that were used were opioids, heroin and cocaine. Only two patients were diabetic, five were hypertensive and one was diagnosed with chronic kidney disease before admission. The most common predisposing factors were IV drug use in (65%), rheumatic heart disease in (22%), followed by patients that had underwent an invasive procedure (16.7%), those who had a recent dental procedure (16.7%), and lastly patients born with congenital heart defects (11.1%). Positive blood cultures were encountered in (95.8%) of patients, with the most common organism being Staphylococcus Aureus in (52.8%) of cases. Three patients had positive fungal cultures for Candida. Most common antibiotics that were used were vancomycin (47.2%), gentamycin (50%), line (27.8%), ampicillin and sulbactam (18.1%), teicoplanin (8%). The three patients that had positive fungal cultures for Candida showed sensitivity for fluconazole. Concerning our echocardiographic findings, we noticed that at least one vegetation was present in every patient. Most patients had only one vegetation (72.2%), the rest had two vegetations. 62 patients (83.3%) had vegetations over 10mm. Native valve affection was present in 63 patients (87.5%) while prosthetic valve affection was in 4 patients representing (5.6%) of patients, VSD related vegetation was in (4.2%) and CIED vegetations represented (2.8%) of all studied patients. Two patients experienced valvular complications, one patient had a mitral valve perforation and the other had a paravalvular leak after recent valve replacement. Pericardial effusion was present in (8.3%) of the studied patients, it was mild in (4.2%), moderate in (2.8%) and severe in (1.4%) of cases All patients had elevated CRP and ESR on admission. Regarding viral markers, (48.6%) were negative for HBV, HCV and HIV. However, (40.3%) had positive viral markers from which 29 were HCV only positive, 2 were HBV only positive, 2 were HIV only positive and 4 were positive for both HBV and HCV. Concerning the outcome of the patients, (81.9%) of patients continued their course of treatment and discharged while in-hospital mortality represented (18.1%).

Conclusion
Our study revealed that the first cause of infective endocarditis in the studied young population was IV addiction. Also, it revealed that the most common organism was staphylococcus aures.