Clinical characteristics, microbiology, and outcomes of infective endocarditis in Qatar

Abstract

Background: Infective endocarditis (IE) is a serious and potentially life-threatening disease. The epidemiology, treatment options, and outcomes have changed considerably over the last two decades. The aim of the study was to describe the epidemiology, clinical characteristics, and outcomes of patients with IE in Qatar. Methods: Patients were identified from Hamad Medical Corporation hospitals’ electronic records, the national referral center for the State of Qatar. We included those aged ≥ 18 years with Duke Criteria-based diagnosis of IE during the period from January 2015 to September 2017. Demographic and clinical data were retrieved. Descriptive statistics were performed, and logistic regression analysis was used to describe the relationship between patient characteristics and all-cause in-hospital mortality. All potentially relevant variables were included in the univariate analysis, while those with p < 0.1 in the univariate logistic regression model were included in the multivariate analysis. For the final model, we calculated odds ratios (OR) adjusted for each of the variables included, along with their 95% confidence intervals (95% CI). Data were analyzed using STATA software version 15 (StataCorp, College Station, Texas, USA). The study was approved by the Institutional Research Board with a waiver for informed consent. Results: Fifty-seven cases were included, of which 70% were males. The mean age was 51 years ( ± 16.8 years). Eleven (19%) were associated with prosthetic valves, and 6 (11%) with implantable cardiac devices. Fever (84%), dyspnea (46%), and heart failure (37%) were the most common presentations. Only 58% of patients had known preexisting valvular heart disease or an intracardiac device. Skin infections (10 patients, 18%) were the most prevalent portals of infection, followed by venous catheters, recent valve surgery, and implantable cardiac devices. Staphylococci were implicated in 19 (34%) and Streptococcaceae in 9 (16%) patients, whereas 21 (37%) patients were culture negative. Left-side IE (49 patients, 86%) was predominant. Acute kidney injury (AKI) (17 patients, 30%) and heart failure (11 patients, 19%) were common complications. The majority of patients received targeted antimicrobial therapy with at least two active agents. Only 9 (16%) patients underwent surgical intervention. Fourteen (25%) patients died of any cause before hospital discharge. Logistic regression analysis identified septic shock [OR 57.8, 95% CI 2.6–1360.2; p < 0.01] and AKI OR 33.9, 95% CI 2.9–398.1; p < 0.01) as the only risk factors independently associated with in-hospital mortality. Conclusion: Staphylococci are the most common microbiological cause of IE in Qatar. Surgical intervention is uncommon, and mortality is relatively high. Our findings suggest that efforts should be directed toward improving IE prevention strategies in high-risk patients, encour...

Clinical and Microbiological Characteristics of Infective Endocarditis at a Cardiac Center in Saudi Arabia

“…In Qatar, MSSA, MRSA, CONS were reported to be 14, 11, 9%, respectively. In our study Viridans group streptococci caused 31.5 and 10.3% of native and prosthetic valve IE, respectively, both Assiri and Zaquot et al reported it to cause 14% [ 12 , 13 ], while Al-Tawfiq et al reported it to cause 17% [ 8 ], none of these studies segregated their microbiology data into native or prosthetic valve IE.…”

“…After prosthetic valves, rheumatic heart disease was the most common risk factor of IE in our study, Assiri also reported it to be the highest risk factor among 44 patients [ 12 ]. The third most common predisposing factor for IE was congenital heart disease reported in almost one-tenth of our study population, which is much higher than that reported in Qatar [ 13 ]. Interestingly, Coxiella burnetii , the causative agent of Q-fever, was common in in our congenital heart disease cohort, this can be explained in part by cardiac implants, bovine jugular transplants and the endemicity of Q-fever in some regions of Saudi Arabia [ 25 ].…”

“…In comparison, a study from a hospital in the Eastern region of KSA by Al-Tawfiq et al on 83 IE patients over a thirteen-year period reported a mean age of 59.7 years [ 8 ], while another study from Aseer region by Assiri on 44 patients over a five-year period reported a mean age of 31 years [ 12 ]. A study by Zaqout et al from Qatar, a neighboring country to KSA, examined 57 patients with IE over a three-year period, they reported the mean age to be 51 years [ 13 ]. Elsewhere data from the United States has shown that more than 50% of all IE cases were seen in patients over the age of 60 years, with a steady increase in the mean age of 45.3 years in the 1980s to 57.2 years in the 2000s [ 14 ].…”

“…Our results demonstrate that 26% of IE cases required surgical intervention, which, like other reports, showed it to be between 25 and 50% during acute infection and 20–40% during convalescence [ 22 – 24 ]. The previous report from Aseer showed that 50% of patients underwent surgery [ 12 ], while only 16% of those in Qatar required surgical intervention [ 13 ]. Over time, the indications for surgery have been extended and valve replacement surgery has been undertaken progressively earlier in the course of the illness.…”

“…The number of native valve IE and prosthetic valve IE were 111 (32.6%) and 109 (32%), respectively, which is nearly equal, one explanation would be the referral of complicated prosthetic valve cases from other hospitals around the whole Kingdom, causing higher reports from developed countries for prosthetic valve IE, the previous report from the Eastern region showed that only 18.5% were prosthetic valve IE [ 8 ], and the study from Aseer region reported it to be 22.7% [ 12 ], while the study from Qatar reported it to be 19% [ 13 ].…”