A 5 YEARS DESCRIPTIVE STUDY ON INFECTIVE ENDOCARDITIS IN ADULTS AT COLONIAL WAR MEMORIAL HOSPITAL, FIJI

Key Words: Infective Endocarditis, Rheumatic Heart Disease, Colonial War Memorial Hospital, Fiji
Introduction: Infective Endocarditis (IE) is a serious infection which occurs mainly in individuals with background valvular heart disease. Fiji has a high prevalence of rheumatic heart disease (RHD) and considering the changing trends of infective endocarditis worldwide, this study aims to describe the demographic characteristics, clinical features, investigation, treatment and outcome of IE at a tertiary referral center in Fiji.
Method: A retrospective descriptive study on IE was carried out from July 2009 to June 2014 at a major tertiary referral center in Fiji. Patients with Duke’s criteria as definite or probable IE were included in the study. Data was analyzed using Microsoft excel and chi square statistical testing.
Results: Sixty eight cases of IE was included in the study, with median age of 33 (95% CI 2.67). RHD was the most common underlying valve disease (65%), with predilection to the indigenous Fijians, referred to as iTaukei (78%, p 0.013).. The commonest findings were fever (87%), anemia (70%), elevated ESR (95%), and valvular vegetations (94%),. Although culture negative IE accounted for 42% of the cases, Staphylococcus aureus remains the commonest isolated pathogen (32%), followed by Beta hemolytic streptococcus (27.5%). Interestingly, Streptococcus viridans was an uncommon pathogen in this series. It was isolated in only 2 cases. Most patients received 28 days of intravenous antibiotic therapy. About 64% of cases had a complicated course, of which cardiac failure was the commonest (40% ) followed by embolic seeding in the brain (15%). The case fatality rate for this series is 17.6%, of which 25% occurred in the first 48hours.
Discussion: This study describes infective endocarditis at one of the three tertiary referral centers in Fiji. Some of the highlights of this study include: 1) rheumatic heart disease is prevalent, 2) changing trends in isolated pathogens, and 3) despite complications and lack of surgical interventions, the case fatality rate is low. As this is is a retrospective study, these findings need to be validated with a prospective study.