Clinical features and outcome of infective endocarditis in Yemeni patients treated with empirical antibiotic therapy

ABSTRACT

Infective endocarditis is a common disease in Yemen. Although the incidence of rheumatic valvular disease and uncorrected congenital heart disease in adults is high in Yemen, there are few data regarding the pattern, characteristic features and outcome of infective endocarditis in Yemen. The aim was to study the characteristic, clinical features and diagnostic criteria of infective endocarditis in Yemeni patients and the outcome in patients treated with medical therapy. Seventy-two consecutive patients admitted to Kuwait teaching hospital in Sana'a with suspected infective endocarditis between June 1, 2005 and June 1, 2007 were included in this study. A questionnaire including history, clinical findings, and result of requested investigations, treatment, complications and outcome was used. The diagnosis was based on Dukes criteria, which proposed two major or five minor criteria. In our study, we included raised erythrocyte sedimentation rate [ESR] as a minor criteria. The patients were classified as definite, possible and rejected cases. All patients received empirical antibiotic therapy. The mean age was 28.56 +/- 14.5 years. Men were 30 [42.2%] while women were 42 [57.7%]. 59 [81.9%] of the patients had been admitted due to fever. Past history of rheumatic heart disease was positive in 38 [53.3%] of the patients. Mitral regurgitation was the commonest form of valvular affection 54 [82.1%] of patients followed by aortic regurgitation in 45 [63%]. Anemia was present in 53 [74%] while raised erythrocyte sedimentation rate was high in all patients. Vegetations were detected by transthorasic echocardiography in 51 [70.83%] of the patients while blood culture was positive in only 7 [9.6%]. After adding high ESR to the criteria, definite infective endocarditis were found in 34 [47.2%]; possible in 38 [52.7%] and no rejected patients. Sixty-two [87.5%] of the patients improved and were discharged in good general condition. Nine patients died, an In hospital mortality of 12.5%. Patients with IE in Yemen were younger than those patients in western countries, RHD is the commonest predisposing factor. Duke's criteria in addition to high ESR as minor criteria improved the diagnostic possibilities and using empirical antibiotic therapy improves the outcome: