ABSTRACT
BACKGROUND: French Polynesia is a French overseas collectivity in the South Pacific Ocean, where data on infective endocarditis (IE) are lacking. AIMS: To investigate the epidemiology and outcomes of IE in French Polynesia. METHODS: All hospital records from consecutive patients hospitalized in Taaone Hospital, Tahiti, from 2015 to 2018, with an International Classification of Diseases, 10th revision, separation diagnosis of IE (I330), were reviewed retrospectively. RESULTS: From 190 hospital charts reviewed, 105 patients with a final diagnosis of IE, confirmed according to the modified Duke criteria, were included. The median duration of follow-up was 71 days (interquartile range 18-163 days). The mean age was 55±17 years, and there were 68 men (65%). Thirty-five patients (33%) had a history of rheumatic carditis and 43 (41%) had a prosthetic valve. There were 40 (38%) cases of staphylococcal IE, 32 (30%) of streptococcal IE and six (6%) of enterococcal IE. Cardiogenic shock, septic shock and clinically relevant cerebral complications were strongly associated with death from any cause (hazard ratio [HR] 16.85, 95% confidence interval [CI] 5.45-52.05 [P<0.001]; HR 2.62, 95% CI 1.23-5.56 [P=0.01]; and HR 4.14, 95% CI 1.92-8.92 [P<0.001], respectively). Seventy-three patients (69%) had a theoretical indication for surgery, which was performed in 38 patients (36%). Lack of surgery when there was a theoretical indication was significantly associated with death (HR 6.93, 95% CI 3.47-13.83; P<0.0001). CONCLUSIONS: The pattern of IE in French Polynesia differs from Western countries in many ways. Postrheumatic valvular disease remains the main underlying disease, and access to emergency heart surgery is still a challenge.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Endocarditis/epidemiology , Endocarditis/therapy , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis/adverse effects , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/therapy , Rheumatic Heart Disease/epidemiology , Rheumatic Heart Disease/therapy , Adult , Aged , Anti-Bacterial Agents/adverse effects , Endocarditis/diagnosis , Endocarditis/mortality , Female , Health Services Accessibility , Heart Valve Prosthesis Implantation/instrumentation , Humans , Male , Middle Aged , Polynesia/epidemiology , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/mortality , Retrospective Studies , Rheumatic Heart Disease/diagnosis , Rheumatic Heart Disease/mortality , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
CONTEXT: Ischemia is an established cause of acute pancreatitis; however, acute pancreatitis has never been reported after cardiac arrest. CASE REPORT: We report a case of acute pancreatitis following cardiac arrest with prolonged cardiopulmonary resuscitation in a 58-year-old man, the mechanism of which is likely to be ischemic. The patient developed severe ischemic encephalopathy, leading to death. Possible causes of acute pancreatitis in a context of cardiopulmonary resuscitation are discussed. CONCLUSION: In case of abdominal distension following cardiac arrest, diagnoses of mesenteric ischemia and acute ischemic pancreatitis should be considered. Such digestive complications occurring after cardiac arrest probably reflect the severity of the ischemia.