title: Determination of bacterial etiological agents, sensitivity pattern and clinical outcome of patients with bacterial endocarditis at Punjab Institute of Cardiology, Lahore.
abstract: OBJECTIVE
  To determine the type of pathogens causing bacterial endocarditis, their in vitro drug susceptibility profile and the effect of empirical antibiotic therapy in endocarditis patients.
  
  
  METHODS
  The prospective study was conducted at the Punjab Institute of Cardiology, Lahore, from January to November 2013. Blood samples of endocarditis patients in the 20-40 age group were collected and culture-positive patients were included in the study. Antibiotics given to patients as empirical therapy were noted. Antimicrobial susceptibility of the isolates against various antibiotics was determined in vitro by using Kirby Bauer disc diffusion technique. The results were interpreted as frequencies and percentages.
  
  
  RESULTS
  Of the 110 endocarditis patients initially scanned, 60(54.5%) were culture-positive and represented the study sample. Of them, 31(51.7%) were men and 29(48.3%) were women. The combination of Benzyl Penicillin and Gentamicin was given to 11(18.3%) patients, while combination of Vancomycin and Gentamicin and Vancomycin alone was also given to 3(5%) and 6(10%) patients respectively. Overall, 53(88.3%) isolates were Gram-positive and 7(11.7%) were Gram-negative. Among Gram-positive isolates, 39(65%) were Methicillin-sensitive Staphylococcus aureus, 2(3.3%) were Methicillin-resistant Staphylococcus aureus and 12(20%) were Streptococcus species. Among the Gram-negative group, 5(8.4%) isolates were of Escherichia coli, 2(3.3%) were of Pseudomonas aeruginosa. In vitro antimicrobial susceptibility of Gram-positive revealed 100% susceptibility to Vancomycin. Pseudomonas aeruginosa showed 100% in vitro susceptibility to Ciprofloxacin, Ceftazidime, Piperacillin+Tazobactam and Tigecycline, while Escherichia coli showed 60% susceptibility to Amikacin and Co-Amoxiclav.
  
  
  CONCLUSIONS
  The frequency of Gram-positive organisms causing endocarditis was high. Vancomycin in Gram-positive cases revealed better in vitro efficacy, while in Gram-negative cases, Ciprofloxacin, Ceftazidime, Piperacillin+Tazobactam, Tigecycline Amikacin and Co-Amoxiclav were more effective than other antibiotics.
authors.forename: Iqra
authors.initials: I
authors.lastname: Fayyaz
authors.forename: Muhammad Adil
authors.initials: MA
authors.lastname: Rasheed
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ashraf
authors.forename: Allah
authors.initials: A
authors.lastname: Bukhsh
authors.forename: Abdul
authors.initials: A
authors.lastname: Wadood
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin