title: Infective endocarditis: a five-year experience at a tertiary care hospital in Pakistan.
abstract: OBJECTIVE
  Infective endocarditis is common and data regarding its pattern and outcome from developing countries is sparse. We therefore examined the spectrum, demographics and clinical features of infective endocarditis and sought to determine the factors affecting its clinical outcome.
  
  
  METHODS
  Over a five-year period at our university hospital in Karachi, Pakistan, we identified 66 patients with infective endocarditis and compared their clinicoepidemiologic features and outcomes to subjects in the West.
  
  
  RESULTS
  The male:female ratio was 2:1; overall median age was 24 years (35.5 years for men and 13.5 years for women) (p < 0.001). Median duration of symptoms before presentation was 20.5 days. Major predisposing cardiac abnormalities included congenital (50%) and rheumatic (23%) lesions, and a history of heart surgery (17%). Causative organisms and valvular sites of infection were similar to those seen in developed countries. Blood culture-negative infective endocarditis was found in 48% of cases. Renal failure was more frequent among culture-positive patients (p = 0.055). Risk factors for mortality included neurologic (p = 0.003) and embolic (p = 0.02) complications, renal (p = 0.03) and left ventricular failure (p = 0.002), and a history of cardiac surgery (p = 0.026). Overall mortality was 27%.
  
  
  CONCLUSIONS
  Patients with infective endocarditis in Pakistan exhibit significant differences compared to their counterparts in the West, including younger age at presentation, incidence of predisposing cardiac conditions, and gender differences reflecting sociocultural bias. Neurologic and embolic complications, renal failure and heart failure predict a worse outcome.
authors.affiliation: The Department of Medicine, The Aga Khan University Medical College, The Aga Khan University, PO Box 3500, Stadium Road, Karachi 74800, Pakistan. muhammad.tariq@aku.edu
authors.forename: Muhammad
authors.initials: M
authors.lastname: Tariq
authors.forename: Mahboob
authors.initials: M
authors.lastname: Alam
authors.forename: Gulminay
authors.initials: G
authors.lastname: Munir
authors.forename: M Ata
authors.initials: MA
authors.lastname: Khan
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Smego
mesh_terms: D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D001769:Blood / Q000382:microbiology; D003470:Culture Media; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D003470:Culture Media