Filiz ÖZERKAN ÇAKAN, Umut KOCABAŞ, Esra KAYA

Türkiye’de üçüncü basamak bir hastanede enfektif endokardit olgularının profili: 15 yıllık deneyimimiz

Amaç: Bu çalışmada üçüncü basamak sağlık hizmetinde enfektif endokardit olgularının klinik, ekokardiyografik ve mikrobiyolojik profili ve hastane komplikasyon ve mortalite oranları değerlendirildi. Çalışma planı: Eylül 2000 - Eylül 2015 tarihleri arasında modifiye Duke kriterlerine göre kesin enfektif endokardit tanısı konan ve tedavi edilen ardışık 210 olgu (138 erkek, 72 kadın; ort. yaş 48.8±17.9 yıl; dağılım 18-89 yıl) retrospektif olarak incelendi. Bulgular: Protez kapak enfektif endokardit oranı %12.3 idi. En sık görülen yatkınlaştırıcı faktör, romatizmal kalp hastalığı (%20.5) idi. Yüz yetmiş dört olguda (%82.9) transtorasik veya transözofageal ekokardiyografi ile vejetasyon saptandı. Etken mikroorganizmalar Stafilokoklar (%30.5), Streptokoklar (%15.2) ve Enterokoklar (%7.6) olmak üzere 119 olguda izole edildi (%56.7). Doksan bir olgunun (%43.3) kültürü negatifti. Cerrahi tedavi 111 olguya (%53) gerekli oldu. Olguların %24’ünde uygun antibiyotik tedavisi ile cerrahi işleme gereksinim olmaksızın tam iyileşme sağlandı. En sık gözlenen komplikasyonlar septik emboli (%25.2) ve konjestif kalp yetmezliği (%13.4) idi. Kırk bir olguda (%19.5) hastane mortalitesi izlendi. Sonuç: Çalışma bulgularımız, enfektif endokarditin halen yüksek hastane mortalite ve morbidite oranları ile ilişkili olduğunu göstermektedir.

Profile of infective endocarditis cases at a tertiary hospital in Turkey: our 15-year experience

Background: This study aims to evaluate the clinical, echocardiographic, and microbiological profile and in-hospital complication and mortality rates of infective endocarditis cases in the tertiary setting.Methods: A total of 210 consecutive cases (138 males, 72 females; mean age 48.8±17.9 years; range, 18 to 89 years) who were diagnosed with definite infective endocarditis based on the modified Duke criteria and treated between September 2000 and September 2015 were retrospectively analyzed.Results: The rate of prosthetic valve infective endocarditis was 12.3%. Rheumatic heart disease was the most common predisposing factor (20.5%). Transthoracic and/or transesophageal echocardiography showed a vegetationin 174 cases (82.9%). Causative microorganisms were identified in 119 cases (56.7%) as Staphylococci (30.5%), Streptococci (15.2%), and Enterococci (7.6%). Cultureswere negative in 91 cases (43.3%). Surgical therapy was necessary in 111 cases (53%). Twenty-four percent of cases had a total recovery with appropriate antibiotheraphy without needing any surgical procedures. The most common complications were septic embolism (25.2%) and congestive heart failure (13.4%). In-hospital mortality occurred in 41 cases (19.5%).Conclusion: Our study results show that infective endocarditis is still associated with high in-hospital mortality and morbidity rates.

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