# Clinical presentation, microbiological profile, and management challenges of infective endocarditis: a retrospective study from a high volume cardiac centre in Pakistan

## TL;DR

This study examines the causes, symptoms, and outcomes of infective endocarditis in Pakistan, highlighting high rates of antibiotic resistance and poor clinical outcomes.

## Contribution

The study provides a detailed analysis of IE in a Pakistani cardiac center, emphasizing local microbiological profiles and management challenges.

## Key findings

- Streptococcus Viridans and Staphylococcus aureus were the most common causative organisms.
- 32.1% of patients had negative cultures, and 43.9% of culture-positive cases showed antibiotic resistance.
- Major Adverse Cardiovascular Events occurred in 56% of patients, with acute kidney injury in 48.8%.

## Abstract

Infective endocarditis (IE) is a potentially fatal condition with high morbidity and mortality. This single center study was designed to assess the clinical presentation, causative organisms, antibiotic resistance, and clinical outcomes of IE in patients treated at a tertiary care cardiac center in Pakistan.

A retrospective observational study was conducted at a large tertiary care cardiology center in Peshawar, Pakistan from July 2021 to July 2023. Data was collected from hospital records, including demographic, clinical, and laboratory parameters. Statistical analysis was performed using Stata version 14.2.

Among 84 patients, 41.7% were male with a mean population age of 49.17 ± 18.55 years, and an average BMI of 27.72 ± 4.37 kg/m2. Hypertension was the most common comorbidity, found in 47.6% patients, followed by diabetes in 36.9% patients. Streptococcus Viridans (25%) was the most common organism isolated, followed closely by Staphylococcus aureus at 22.6%. Surprisingly, 32.1% of the patients had negative cultures. Antibiotic resistance was observed in 25/57 (43.9%) of culture positive cases, and Major Adverse Cardiovascular Events (MACE) occurred in 56%. Acute kidney injury was observed in 48.8% of the patients.

IE presents diverse etiologies and outcomes, necessitating targeted management strategies to reduce antibiotic resistance and improve outcomes in such a challenging subsets of patients.