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Arora N, Panda PK, Cr P, Uppal L, Saroch A, Angrup A, Sharma N, Sharma YP, Vijayvergiya R, Rohit MK, Gupta A, Sihag BK, Gupta H, Dahiya N, Bahl A, Singh P, Mehrotra S, Barwad P, Pannu AK. Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India. Indian Heart J 2021; 73:711-717. [PMID: 34861981 PMCID: PMC8642647 DOI: 10.1016/j.ihj.2021.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Several studies have demonstrated a shift in the spectrum of infective endocarditis (IE) in the developed world. We aimed to investigate whether demographic and microbiologic characteristics of IE have changed in India. Design A retrospective analysis of patients with in north India between 2010 and 2020. Methods The clinical and laboratory profiles of 199 IE admitted to an academic hospital patients who met the modified Duke criteria for definite IE were analysed. Results The mean age was 34 years, and 84% were males. The main predisposing conditions were injection drug use (IDU) (n = 71, 35.7%), congenital heart disease (n = 46, 21.6%), rheumatic heart disease (n = 25, 12.5%), and prosthetic device (n = 19, 9.5%). 17.1% of patients developed IE without identified predispositions. Among 64.3% culture-positive cases, the most prevalent causative pathogens were Staphylococcus aureus (46.1%), viridans streptococci (7.0%), enterococci (6.0%), coagulase-negative staphylococci (5.5%), gram negative bacilli (5.5%), polymicrobial (5.5%), and Candida (1.0%). The tricuspid (30.3%), mitral (25.6%), and aortic (21.6%) valves were the most common sites of infection, and 60.3% had large vegetations (>10 mm). Systemic embolization occurred in 55.3% of patients at presentation. Cardiac surgery was required for 13.1%. In-hospital mortality was 17.1% and was associated with prosthetic devices (p-value, 0.001), baseline leucocytosis (p-value, 0.036) or acute kidney injury (p-value, 0.001), and a microbial etiology of gram negative bacilli or enterococci (p-value, 0.005). Conclusion IDU is now the most important predisposition for IE in India, and S. aureus has become the leading cause of native valve endocarditis with or without IDU.
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Affiliation(s)
- Navneet Arora
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Prashant Kumar Panda
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pruthvi Cr
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Lipi Uppal
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Atul Saroch
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Archana Angrup
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Yash Paul Sharma
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ankur Gupta
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Bhupinder Kumar Sihag
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Himanshu Gupta
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Neelam Dahiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Parminder Singh
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Saurabh Mehrotra
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Parag Barwad
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ashok Kumar Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Uppal L, Rohit MK, Barwad P, Naganur S, Debi U, Kasinadhuni G, Santosh K, Cr P, Sahoo S. Comparison of isolated venous approach with the standard approach in children undergoing patent ductus arteriosus device closure. Egypt Heart J 2020; 72:65. [PMID: 32990909 PMCID: PMC7524916 DOI: 10.1186/s43044-020-00100-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/21/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Transcatheter device closure is a safe procedure recommended in children with patent ductus arteriosus (PDA). While the standard procedure uses arterial and venous femoral access, it poses risk of vascular complications especially in young infants. Isolated venous approach has been tried in a few studies and was found to be non-inferior to the standard technique. In this prospective observational study, we have compared the two vascular approaches of PDA device closure in pediatric patients and have also studied the feasibility of this approach in young children with weight < 6 kg. RESULTS PDA device occlusion was performed with either one of the approaches-venous alone (group I) or standard approach (group II) in a total of 135 children enrolled prospectively. The baseline data, procedural outcomes, vascular complications, and radiation dose were compared between the two groups. Fifty-two and 83 children were included in group I and group II, respectively. A total of 22 children (16%) (13 in group I; 9 in group II) had weight < 6 kg. In group II, 6 children (7.2%) had vascular site complications treated with heparin infusion with two children requiring thrombolysis. Another child in group II developed intravascular hemolysis following residual shunt, requiring surgical device retrieval and closure. No significant differences were observed in mean fluoroscopic time (p = 0.472) and air kerma between the two groups (p = 0.989). CONCLUSION Transcatheter PDA device closure without arterial access is a feasible and safe option in children including young infants. This technique avoids the risk of vascular complications although requires careful case selection.
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Affiliation(s)
- Lipi Uppal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Parag Barwad
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjeev Naganur
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Uma Debi
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pruthvi Cr
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Saroj Sahoo
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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