Active Infective Endocarditis Observed in an Indian Hospital 1981-1991 Rajib Choudhury, MD, Anil Grover, MD, Jagmohan Varma, MD, Hari N. Khattri, FRCP, lnder S. Anand, FRCP, Padmakar S. Bidwai, MD, Purshottam L. Wahi, MD, and Rajendra P. Sapru, PhD Clinkal data from 166 patients (133 make and 53 females) with IS6 episodes of infective endocarditis (IE) occurring between January 1981 and July 1991 were studied retrospectively at a large referral hospital in Northern India with the intention of highlighting certain essentiil differences from those reported in the West. The mean age was much lower (25 f SD 12 years, range 2 to 75 years). Rheumatic heart disease was the most frequent underlying heart lesion accounting for 79 patients (42%). This was followed by congenital heart disease in 62 (33%) and normal valve endocarditis in 17 (9%). Twenty-four patients had etther aortic regurgitation (n = 15) or mitral regurgitation (n = 9) of uncertain etioiogy. Prosthetic valve infection and mitral vaive proiapse were present In only 2 patients each. A definite predisposing factor could be identified in only 26 patients (15%). Postabortal sepsis and sepsis related to chiidbbth accounted for 6 and 5 cases, respectively. Only 1 patknt had history of intravenous drug abuse. Two-dimensional echocardiography showed vegetations in 121 patients (64%). Blood cultures were positive in only 87 (47%), with a total of 90 microbtal isoiates. Commonest infecting organisms were staphyiococci (37 cases) and streptococci (34 cases). Except for a dgnifkantly higher number of patients with neuroiogk complications in the culture-negative group, there were no differences between patients with cuiture-positive and cuiture-negative IE. Of the 190 episodes of IE, the patients had received antibiotics before admission in 110 (66%) instances. A significantly greater number of culture-negative patients had received antibiotks than did culture-positive patients (87 VI 23, p l site. lnfaeting ogcnirmr (Table V): On an average,in a patient suspectedto have IE, 4 to 6 blood samplesof 10 ml volume each were collected from different sites over a period of 24 hours. The standard methodsfor aerobic, anerobic and fungal cultures were used. Blood cultures were positive in 87 patients (47%), with a total of 90 microbial isolates.Three patients had polymicrobial infection. Staphylococca1 speciesconstituted the largest number of isolates (37 cases)followed by streptococcal species(34 cases).A comparison of patients who were culture-positive with those who were culture-negative did not reveal any significant differencesin age, sex raACTIVE INFECTIVE ENDOCARDITIS

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TABLE V Microbial Organisms Isolated in 190 Episodes of Active Infective Endocarditis Staphylococcus Staphylococcus aureus Staphy/ococcus epidermidis Streptococcus Streptococcus viridans Streptococcus mitior Streptococcus fecalis Streptococcus mutans Group A streptococcus Gram negative Klebsiella pneumoniae fscherichia co/i Salmonella typbi Acinetobacter Proteus mirabilis Enterobacteraerogenes Citrobacter freundi Neisseria gonorrhoea Candida species

37 32 5 34 15 11 4 1 3 17 5 4 2 2 1 1 1 1 2

TABLE VI Comparison of Culture-Positive and Culture-Negative (190 episodes of active infective endocarditis)

No.of pts. Age (years) Male/female Duration of fever (days) Prior antibiotic therapy Predisposing factors Complications Cardiovascular Neurologic Renal Emboli Site of vegetations Mitral valve Aortic valve Tricuspid valve Pulmonic valve Others Mortality

Culture Positive

Negative

Culture

87 (46%) 26 2 12 2.5:1 69 f 59 23 (26%) 16 (18%)

103 (54%) 24-c 11 2.6:1 68 + 68 87 (84%) 12 (12%)

p Value NS NS