146: Native valve infective endocarditis in a tertiary care center in a Tunisian context: Clinical aspects and predictors events

Background Despite significant progress made in diagnostic and therapeutic modalities, infective endocarditis (IE) remains a serious affection associated with considerable mortality and morbidity. Aim To describe the epidemiological and clinical aspects of native valve infective endocarditis (IE) in a Tunisian high-volume tertiary care center and to identify the predictors of outcome. Methods and results Demographic, clinical, laboratory, and echocardiographic characteristics were examined in 176 patients who fulfilled the modified Duke criteria for native valve IE between January 1993 and December 2008. Logistic regression analysis was used to identify prognostic factors for death. Mean age was 36.1±7.5 years. Diagnosis was definite in 85% of cases. Median time to diagnosis was 19 days. Rheumatic heart disease (RHD) was the predominant (47%) underlying heart condition. Mitral valve location was the most frequent seat of IE (37.7%). One or more vegetations were detected in more than 86.8% of cases. The median size of vegetation was >15 mm in 26% of cases. In 84 cases (48.5%), cultures remained negative. Serology was positive in 16 cases, and in 4 cases leaflet culture identified the agent. Causative microorganisms were mainly Staphylococci (n=42 (24.2%), including 8 coagulase-negative Staphylococcus), and Streptococci (n=32). Overall mortality was 18.6%. On multivariate analysis, congestive heart failure (hazard ratio = 5.62, 95% CI 1.32 to 12.54, p=0.008) and large vegetations (>15 mm; hazard ratio = 4.28, 95% CI 1.91 to 11.69, p=0.004) and neurological complications (hazard ratio = 3.27, 95% CI 1.84 to 9.11, p=0.002) were predictive of in-hospital mortality. Conclusion IE remains a serious disease affecting a young population in Tunisia, with RHD as still the most common underlying heart disease, and it is associated with a high mortality.