Prevention of Infective Endocarditis, should Developing Country have Concern with the Guidelines?

The published guidelines of Infective endocarditis (IE) markedly restricting the use of antibiotic prophylaxis for prevention of IE resulted in some controversy. The aim of this study is to attempt to answer the question – Should the developing country have a concern of rising incidence of IE with the current guidelines? Retrospective analysis of all reported cases of definitive IE based on modified Duke Criteria in tertiary hospital over a 5-year period. 20 reported cases of IE, 9 males (45%) and 11 females, mean age 36 years (12 days- 72 years); one patient had history of rheumatic heart disease, 4 patients (20%) had congenital heart disease. 14 patients (70%) had history of a prior procedure. Blood cultures were positive in 16 patients (80%), with culture-negative IE in 4 patients. The most common organisms were Staphylococcus spp. In 9 patients (45%), Enterococcus spp. Was isolated in 2 patients (10%), Gram negative bacilli isolated in 2 patients, one Enterobacter and one Acinetobacter bummani. There was one case of streptococcal IE, the usual target for prophylactic antibiotics and the patient had received prophylactic antibiotics peri-procedurally. Most organisms were acquired nosocomially and/or after procedures which did not require prophylactic antibiotics under any previous or current guidelines. IE is uncommon disease in our practice representing only 0.017% of total admissions and complicating only one dental procedure out of 101,825. The current guidelines for IE antibiotic prophylaxis did not carry extra risk in developing country, but preferably we may continue to collect relevant data.