Abstract 43: Evolving Spectrum and Short-Term Outcomes of Infective Endocarditis in North India And Comparison Between Intravenous Drug Users and Non-Users

Abstract

Background: Patterns of infective endocarditis (IE) are changing in developed nations, with increasing cases linked to intravenous drug use. It remains uncertain whether similar trends apply to developing nations like India, where data on IVDU-associated IE are limited. This study aimed to describe the clinical characteristics, risk factors, etiology, echocardiographic findings, management, complications, and short-term outcomes of IE, and to compare profiles between IVDU and non-IVDU patients. Methods: A retrospective analysis was conducted on 163 patients admitted between January 2017 and December 2021 who met the Modified Duke criteria for IE. Demographic, clinical, and laboratory data were collected. All patients underwent transthoracic echocardiography, and transesophageal studies were performed when indicated. Results: The majority (62.6%) were aged 18–40 years; 77.3% were male. Common presenting symptoms were fever (89.0%) and dyspnea (53.4%). Frequent peripheral signs included splenomegaly (28.2%), clubbing (8%), and splinter hemorrhages (7.4%). Laboratory abnormalities included anemia (84.7%) and elevated ESR (83.4%). Major cardiac risk factors were aortic valve disease (6.7%) and rheumatic heart disease (5.5%), while non-cardiac risk factors included IVDU (38%), orodental infection/procedure (14.1%), and diabetes mellitus (14.1%). Complications included septicemia (66.3%), renal failure (42.3%), hepatic dysfunction (31.9%), heart failure (24.5%), septic pulmonary infarction (9.2%), and stroke (8%). Blood cultures were positive in 49.3%; Staphylococcus aureus (25.2%) was the predominant organism, followed by Pseudomonas aeruginosa (7.4%). Surgical intervention was done in 11.7%. Overall mortality was 22.1%, and 22.6% among IVDU patients. Death was primarily due to refractory heart failure (47.2%), persistent infection (30.6%), and renal failure (22.2%). Conclusion: IE continues to cause significant morbidity and mortality in developing countries. The rising prevalence of IVDU-associated IE, predominance of S. aureus , low culture positivity, and limited surgical intervention rates highlight emerging challenges. The clinical profile of IVDU differs significantly from non-IVDU, underscoring the need for early diagnosis and timely surgical management to improve outcomes.