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Original research article
Infective endocarditis in the Pacific: clinical characteristics, treatment and long-term outcomes
  1. Mariana Mirabel1,2,3,
  2. Romain André1,
  3. Paul Barsoum Mikhaïl1,4,
  4. Hester Colboc5,
  5. Flore Lacassin5,
  6. Baptiste Noël4,
  7. Jacques Robert4,
  8. Marie Nadra4,
  9. Corinne Braunstein4,
  10. Shirley Gervolino6,
  11. Eloi Marijon1,2,3,
  12. Bernard Iung7 and
  13. Xavier Jouven1,2,3
  1. 1INSERM U970, Paris Cardiovascular Research Centre—PARCC, Paris, France
  2. 2Université Paris Descartes, Sorbonne Paris Cité, Paris, France
  3. 3Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
  4. 4Cardiology Department, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
  5. 5Department of Internal Medicine and Infectious Disease, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
  6. 6Department of Bioinformatics, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
  7. 7Cardiology Department, Hôpital Bichat and Paris Diderot University, Paris, France
  1. Correspondence to Dr Mariana Mirabel; mariana.mirabel{at}inserm.fr

Abstract

Introduction Data on clinical characteristics and outcomes of infective endocarditis (IE) in the Pacific are scarce.

Methods Retrospective hospital-based study in New Caledonia, a high-income country, on patients aged over 18 years with definite IE according to the modified Duke criteria (2005–2010).

Results 51 patients were included: 31 (60.8%) men; median age of 52.4 years (IQR 33.0–70.0). Left-sided IE accounted for 47 (92.2%) patients: native valve IE in 34 (66.7%) and prosthetic valve IE in 13 (25.5%). The main underlying heart disease included: rheumatic valve disease in 19 (37.3%), degenerative heart valve disease in 12 (23.5%) and congenital heart disease in 6 (11.8%). Significant comorbidities (Charlson's score >3) were observed in 20 (38.7%) patients. Infection was community acquired in 43 (84.3%) patients. Leading pathogens included Staphylococcus aureus in 16 (31.4%) and Streptococcus spp in 15 (29.4%) patients. Complications were noted in 33 patients (64.7%) and 24 (47.1%) were admitted to the intensive care unit. Cardiac surgery was eventually performed in 22 of 40 (55.0%) patients with a theoretical indication. None underwent emergent cardiac surgery (ie, first 24 h); 2 (3.9%) were operated within 7 days; and 20 (39.2%) beyond 7 days. 11 (21.6%) patients died in hospital and 21 (42.9%) were dead after a median follow-up of 28.8 months (IQR 4.6–51.2). Two (3.9%) were lost to follow-up.

Conclusions In New Caledonia, IE afflicts relatively young patients with rheumatic heart disease, and carries high complication and mortality rates. Access to heart surgery remains relatively limited in this remote archipelago.

  • VALVULAR DISEASE

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