Profile, Presentation and Outcomes of Prosthetic Valve Endocarditis in a South African Tertiary Hospital: Insights From the Groote Schuur Hospital Infective Endocarditis Registry

Background Prosthetic valve infective endocarditis (PVE) is associated with high morbidity and mortality. The prevalence of PVE in local retrospective studies ranges between 13% and 16%. However, the clinical patient profile and outcomes remains unknown. Methods We performed a prospective observational study of patients presenting or referred to Groote Schuur Hospital with definitive or probably infective endocarditis based on the 2015 European Society of Cardiology (ESC) infective endocarditis diagnostic criteria. Consenting adult patients who met inclusion criteria were enrolled into the Groote Schuur Hospital Infective Endocarditis Registry which was approved by the University of Cape Town Human Research Ethics. The current study is an analysis of the cohort of patients who were enrolled between 01/01/2017 to 31/12/2019. The primary objective of this study was to define the clinical profile and outcomes of patients with PVE. The secondary objective aimed to compare the clinical profile and outcomes of PVE patients with those of native valve endocarditis patients (NVE). Results During the study period a total of 135 patients received a diagnosis of possible and definitive infective endocarditis (IE). Of these, 18 patients had PVE and 117 patients NVE. Therefore, PVE accounted for 13.3% of the overall IE cohort. PVE patients had mean (Standard Deviation) age of 39.1 (14.6) years, 56.6% were male. PVE occurred within one year of valve surgery in 50% and the Duke's modified diagnostic criteria for definitive IE was met in 94.4% of the PVE cohort. Prosthetic valves in the aortic position were affected in isolation or in combination with prostheses in the mitral area in 66.7%. Further, tissue prosthetic valves were affected in 61.1% of the PVE cases. 55.6% of the PVE cases were health care associated. On transthoracic echocardiography, vegetations (61.1%), prosthetic valve regurgitation (44.4%) and abscess (22.2%) were discovered. Staphylococcus species and streptococcus species accounted for 38.8% and 22.2% of PVE cases, respectively. 27.8% cases were blood culture negative. Valve surgery was performed in 38.7% of the PVE patients. 55.6% of the PVE patients demised during the index hospitalisation. The secondary analysis indicated that the PVE patients were sicker, with a higher frequency of septic shock and heart block than the NVE patients, 22.2% vs 7% p= 0.02 and 27.8% vs 12% p =0.04 respectively. In addition, in hospital mortality was higher in PVE patients than NVE patients, 55.6% vs 31.6% p=0.04. Conclusion PVE is relatively uncommon in resource-limited settings and is associated with a high in hospital mortality. Staphylococcus and streptococcus species are the leading microbiological causes of PVE. The selected PVE patients that receive surgical treatment for endocarditis demonstrate better in-hospital survival than those who do not receive surgical treatment. This finding not only reaffirms the importance of surgery as treatment option for IE but further demonstrate the importance of the Heart team in selecting appropriate surgical candidates.

Grantor

Department of Medicine

Year dc:date.issued

2022

Author dc:creator

• Mkoko, Philasande

Advisor dc:contributor.advisor

• Ntsekhe, Mpiko

• Cardiology

Handle dc:identifier.uri

http://hdl.handle.net/11427/37573

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/37573