Epidemiology, outcomes and prognosis of infective endocarditis in Northern Morocco

TL;DR

This study examines the epidemiology, treatment, and outcomes of infective endocarditis in northern Morocco over nearly five years.

Contribution

The paper provides region-specific data on infective endocarditis in northern Morocco, comparing it to international guidelines.

Findings

Staphylococcus was the most common causative organism in 65.6% of cases.

Heart failure was the most frequent complication, affecting 51.2% of patients.

A mortality rate of 12.5% was observed, with 15% of patients undergoing surgery.

Abstract

Infective endocarditis is a rare but potentially severe disease, associated with significant morbidity and mortality. Our study aims to describe the epidemiology and management aspects of endocarditis in northern Morocco and compare it with international management guidelines.

This is a retrospective study involving all patients hospitalized in the cardiology department of the University Hospital of Tangier for infective endocarditis over a period of 4 years and 7 months, from May 2019 to February 2024.

Eighty patients were hospitalized for IE during the study period. The average age of the patients was 46 years, with an even sex ratio. IE concerned native valves in 77% of cases, mechanical prostheses in 19% of cases, and on bio prostheses in 4%. The average diagnostic delay was 25 days. Blood cultures were negative in 59% of cases. The predominant infective microorganism was the bacteria Staphylococcus (65.6%).

Imaging results showed vegetations in 76.3% of cases, predominantly on the mitral valve (39.3%), followed by the aortic valve (21.3%). The main complications included heart failure (51.2%), peripheral arterial embolisms (22.5%) and splenic infarction (17.5%).

Management wise, the most commonly used antibiotic therapy was a combination of ceftriaxone and gentamicin. Clinical and biological improvement was observed in 70% of cases, with a mortality rate of 12.5%. Twelve patients underwent surgery (15%). Urgent surgery was indicated in 66,7% of the operated patients.

Our study highlights the challenges in managing infective endocarditis in northern Morocco. The prognosis of infective endocarditis can be improved through multidisciplinary management within the implementation of an Endocarditis Team.

­ - Infective endocarditis is a rare but severe disease. Guidelines are updated frequently to perfect the assessment and management of this condition.

­ - Complications of IE should be assessed systematically to improve prognosis

­ - Our study proves that the epidemiological data in the guidelines concerning countries where rheumatic heart disease is endemic is similar and compatible with our results.

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