A Prospective Study to Analyse the Agreement between Empirical Antimicrobials used in Infective Endocarditis and Culture Sensitivity Reports FC05-FC09
Dr. Remya Reghu,
Assistant Professor, Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi-682041, Kerala, India.
Introduction: Infective Endocarditis (IE) is defined as a microbial infection of the heart valve or the mural endocardium. Annually the incidence of IE is between 2 and 6 per 100,000 individuals. The diagnostic techniques for IE and selection of empiric antibiotics remain a big challenge in the light of changing microbiological spectrum for IE.
Aim: To identify the risk factors of IE, to identify the specific pathogens involved, the empirical therapy provided and to analyse the agreement between the empirical therapy and the culture sensitivity reports.
Materials and Methods: The study was a non experimental, descriptive and prospective type of study involving patients diagnosed with IE and fitting into the inclusion and exclusion criteria. This study was conducted on patients admitted under Cardiology department of Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Information on risk factors, empirical antibiotic therapy, culture sensitivity report and definitive therapy in IE were collected by accessing the hospital information system. Statistical analysis has been carried out using Chi-square test.
Results: The most common non predisposing and predisposing risk factors were diabetes mellitus 30% and rheumatic heart disease 35% respectively. The most commonly identified organisms in blood cultures were Streptococcus and Staphylococcus species. Majority of the patients with native 46% and prosthetic endocarditis 57% had undergone a change in their therapy according to the culture sensitivity report.
Conclusion: Optimal empirical antibiotic selection is essential in treating IE because after the culture report, altering antibiotics may lead to increased chances for unintended antibiotic resistance. Isolation of atypical pathogens like Pseudomonas aeruginosa and Mycobacterium abscessus implies changes in the microbiological spectrum for this disease.