Clinical Spectrum of Infective Endocarditis in a Tertiary Care Centre in Western India: A Prospective Study


OBJECTIVES: We examined the microbiological spectrum, clinical profile, echocardiographic features and in-hospital outcomes of patients with definitive IE. METHODS: A total of 75 consecutive cases of definitive infective endocarditis (IE), admitted between January 2011 and January 2013, were included in the study. This was a prospective study enrolling all the consecutive definitive cases of IE admitted at U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India. Only the patients who met the modified Duke’s definitive criteria for IE were included in the study. We compared enrolled patients clinicoepidemiologic features and outcomes to subjects in the west. RESULTS: The mean age was 27.46 ± 17.11 years with a male preponderance (2.26:1). The rheumatic heart disease (41.3%) was the commonest underlying disease followed by coronary heart disease (34.7%). The blood culture was positive in 40% of episodes with commonest organisms being staphylococci (16%) and streptococci (12%). Complications were cardiovascular in 40 (53.3%) cases (congestive heart failure in 42.7%, atrioventricular block in 6.7%), septic shock in 20 (26.7%), neurological in 23 (30.7%) (cerebrovascular stroke in 20%, central nervous system hemorrhage in 5.3%, encephalopathy in 5.3%) and renal failure in 20 (26.7%) of cases respectively. Only 12 (16%) patients underwent surgery for IE. The total in hospital mortality rate was 22 (29.3%). On multivariate analysis, congestive heart failure, renal failure, neurological abnormalities, age < 20 years and septic shock were independent predictors of mortality. CONCLUSIONS: The spectrum of infective endocarditis is different in Indian population compared to the west and carries a substantial morbidity and mortality. The rheumatic heart disease is still the commonest underlying heart disease in our population. The culture positivity rates and surgery for infective endocarditis are unacceptably low. Early cardiac surgery may help to improve the outcomes of these patients.

Share and Cite:

Jain, S. , Prajapati, J. , Phasalkar, M. , Roy, B. , Jayram, A. , Shah, S. , Singh, T. and Thakkar, A. (2014) Clinical Spectrum of Infective Endocarditis in a Tertiary Care Centre in Western India: A Prospective Study. International Journal of Clinical Medicine, 5, 177-187. doi: 10.4236/ijcm.2014.55031.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Baddour, L.M., Wilson, W.R., Bayer, A.S., Fowler Jr., V.G., Bolger, A.F., Levison, M.E., et al. (2005) Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: Endorsed by the Infectious Diseases Society of America. Circulation, 111, e394-e434.
[2] Moreillon, P. and Que, Y.A. (2004) Infective Endocarditis. Lancet, 363, 139-149.
[3] Watanakunakorn, C. and Burkert, T. (1993) Infective Endocarditis at a Large Community Teaching Hospital, 1980-1990. A Review of 210 Episodes. Medicine, 72, 90-102.
[4] Prendergast, B.D. (2006) The Changing Face of Infective Endocarditis. Heart, 92, 879-885.
[5] Steckelberg, J.M. (2006) Changing Epidemiology of Infective Endocarditis. Current Infectious Disease Reports, 8, 265-270.
[6] Tornos, P., Iung, B., Permanyer-Miralda, G., Baron, G., Delahaye, F., Gohlke-Bärwolf, C., et al. (2005) Infective Endocarditis in Europe: Lessons from the Euro Heart Survey. Heart, 91, 571-575.
[7] Murdoch, D.R., Corey, G.R., Hoen, B., Miró, J.M., Fowler Jr., V.G., Bayer, A.S., et al. (2009) Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st Century: The International Collaboration on Endocarditis-Prospective Cohort Study. Archives of Internal Medicine, 169, 463.
[8] Choudhury, R., Grover, A., Varma, J., Khattri, H.N., Anand, I.S., Bidwai, P.S., et al. (1992) Active Infective Endocarditis Observed in an Indian Hospital 1981-1991. The American Journal of Cardiology, 70, 1453-1458.
[9] Garg, N., Kandpal, B., Garg, N., Tewari, S., Kapoor, A., Goel, P., et al. (2005) Characteristics of Infective Endocarditis in a Developing Country-Clinical Profile and Outcome in 192 Indian Patients, 1992-2001. International Journal of Cardiology, 98, 253-260.
[10] Letaief, A., Boughzala, E., Kaabia, N., Ernez, S., Abid, F., Chaabane, T.B., et al. (2007) Epidemiology of Infective Endocarditis in Tunisia: A 10-Year Multicenter Retrospective Study. International Journal of Infectious Diseases, 11, 430-433.
[11] Tariq, M., Alam, M., Munir, G., Khan, M.A. and Smego Jr., R.A. (2004) Infective Endocarditis: A Five-Year Experience at a Tertiary Care Hospital in Pakistan. International Journal of Infectious Diseases, 8, 163-170.
[12] Koegelenberg, C., Doubell, A., Orth, H. and Reuter, H. (2003) Infective Endocarditis in the Western Cape Province of South Africa: A Three-Year Prospective Study. QJM, 96, 217-225.
[13] Math, R.S., Sharma, G., Kothari, S.S., Kalaivani, M., Saxena, A., Kumar, A.S., et al. (2011) Prospective Study of Infective Endocarditis from a Developing Country. American Heart Journal, 162, 633-638.
[14] Kothari, S., Ramakrishnan, S. and Bahl, V. (2005) Infective Endocarditis—An Indian Perspective. Indian Heart Journal, 57, 289.
[15] Bayliss, R., Clarke, C., Oakley, C., Somerville, W., Whitfield, A. and Young, S. (1983) The Microbiology and Pathogenesis of Infective Endocarditis. British Heart Journal, 50, 513-519.
[16] Kaye, D. (1985) Changing Pattern of Infective Endocarditis. The American Journal of Medicine, 78, 157-162.
[17] van der Meer, J.T., Thompson, J., Valkenburg, H.A. and Michel, M.F. (1992) Epidemiology of Bacterial Endocarditis in The Netherlands. I. Patient Characteristics. Archives of Internal Medicine, 152, 1863-1868.
[18] Netzer, R.O., Zollinger, E., Seiler, C. and Cerny, A. (2000) Infective Endocarditis: Clinical Spectrum, Presentation and Outcome. An Analysis of 212 Cases 1980-1995. Heart, 84, 25-30.
[19] Von Reyn, C.F., Levy, B.S., Arbeit, R.D., Friedland, G. and Crumpacker, C.S. (1981) Infective Endocarditis: An Analysis Based on Strict Case Definitions. Annals of Internal Medicine, 94, 505-518.
[20] Jalal, S., Khan, K.A., Alai, M.S., Jan, V., Iqbal, K., Tramboo, N.A., et al. (1999) Clinical Spectrum of Infective Endocarditis: 15 Years Experience. Indian Heart Journal, 50, 516-519.
[21] Siddiq, S., Missri, J. and Silverman, D.I. (1996) Endocarditis in an Urban Hospital in the 1990s. Archives of Internal Medicine, 156, 2454.
[22] Taams, M.A., Gussenhoven, E.J., Bos, E., de Jaegere, P., Roelandt, J., Sutherland, G.R., et al. (1990) Enhanced Morphological Diagnosis in Infective Endocarditis by Transoesophageal Echocardiography. British Heart Journal, 63, 109-113.
[23] Olaison, L. and Pettersson, G. (2002) Current Best Practices and Guidelines: Indications for Surgical Intervention in Infective Endocarditis. Infectious Disease Clinics of North America, 16, 453-475.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.