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Infective Endocarditis in the Central Coast of New South Wales, Australia: A Snapshot

Nyakudarika E, O’Loughlin A, Andrew Hill

Background: The epidemiology and management of infectious endocarditis (IE) in the Central Coast has not, to the best of our knowledge, been previously described. We sought to characterize it and shed light on any peculiarities that may define IE in the Central Coast. Methods: Retrospective review of details of patients who admitted in the hospital and undergone a diagnosis of IE over a three-year period was done. We paid particular attention to risk factors for IE and results of blood cultures, cardiac ultrasonography and other imaging. We looked at patient outcomes. A total of 78 admissions fulfilled the inclusion criteria for the study. Patients with more than one admission during the study period were counted as one, leaving a total of 63 patients. Of the 63 patients included, 9 were incorrectly diagnosed as having IE. Results: Ten patients (18.5%) had a history of current or prior intravenous drug use (IVDU). IVDU was associated with smoking, a greater likelihood of more than one admission with IE-related issues, younger age and hepatitis B and/or C infection. Staphylococcus aureus infection accounted for the greatest number of cases of IE, present in 17 patients (31%). Most cases of S. aureus infection were methicillin sensitive (15 patients of 17 patients (88%)). Streptococcus was the second most prevalent pathogen. Gentamicin, used alone or in combination, was the most commonly used antimicrobial agent. All patients underwent transthoracic echocardiography (TTE) at least once and 50 patients (89%), transesophageal echocardiography (TEE). The aortic valve (AV) was the most commonly affected, being involved in 25 patients (44%), and followed by the mitral valve (MV). Twenty four patients, representing 48%, were transferred to a tertiary hospital with cardiothoracic surgery availability. During the study period, there were 4 deaths, representing 7% mortality. Conclusions: Aortic valve involvement was the commonest valve lesion. Prosthetic valves conferred the greatest risk for IE. Most cases of IE were due to methicillin sensitive S. aureus (MSSA) infection and gentamicin was the most commonly used antimicrobial therapy. Cases of misdiagnosis were due to non-adherence to established diagnostic criteria.