title: Clinical, echocardiographic and microbiological study, and analysis of outcomes of infective endocarditis in tropical countries: a prospective analysis from India.
abstract: OBJECTIVE
  The aim of this prospective observational study was to evaluate the clinical, echocardiographic, microbiological profile and outcomes of patients with definitive infective endocarditis (IE) in tropical countries.
  
  
  METHODS
  Between September 2010 and March 2013, a total of 109 patients with 111 episodes of definitive IE (as per the modified Duke's criteria) was enrolled in the study. The mean age at presentation was 32.7 ± 17.2 years (range: 2-70 years), and there was a male preponderance (3:1).
  
  
  RESULTS
  Native valve disease was identified in 57 cases of IE, followed by congenital heart disease (n = 35), prosthetic valve disease (n = 11), normal valves (n = 5) and pacemaker lead infection (n = 1). Echocardiography was diagnostic in all patients except one. Positive blood cultures were obtained in 68 episodes, with streptococci (n = 34) and staphylococci (n = 11) the most common organisms. At least one major complication was identified in 60 patients. Ultimately, only 15 patients underwent surgery for IE, but 25 died during their hospital stay. On multivariate analysis, prosthetic valve involvement, combined mitral and aortic valve involvement, male gender, and leukocytosis were independent predictors of mortality.
  
  
  CONCLUSIONS
  IE in India is associated with a higher mortality and lower rates of culture positivity compared to the west; rates of surgery for IE in India are unacceptably low. Changing epidemiological trends may pose newer challenges in the near future.
authors: Kamal
authors: K
authors: Gupta
authors: Naveena
authors: N
authors: Jagadeesan
authors: Navin
authors: N
authors: Agrawal
authors: Prabhavathi
authors: P
authors: Bhat
authors: Manjunath C
authors: MC
authors: Nanjappa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004697:Endocarditis, Bacterial / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014329:Tropical Climate; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents