Study of the clinical and microbiological profile of patients with endocarditis and cancer – A case series from Tertiary care cancer hospital in Western India

Endocarditis is rare and can be life-threatening in patients with cancer. We sought to evaluate the clinical and microbiological profile of patients of cancer who developed endocarditis.

We retrospectively analyzed transthoracic echocardiograms done in our hospital along with the clinical data stored in computerized medical records between 2016-2018. Infective Endocarditis was diagnosed by using modified Duke criteria. Patients with valvular verrucae and sterile blood cultures were considered to have culture-negative endocarditis.

There were 10 patients of cancer who were diagnosed with endocarditis. All patients had developed endocarditis after the diagnosis of cancer. 5(50%) patients had hematological malignancy. The aortic valve was involved in 5 (50%) patients. Blood cultures were sterile in 7(70%) patients. Out of the 3 patients with positive blood cultures, 2 were positive for Klebsiella pneumoniae and 1 grew Candida tropicalis.

5 (50%) patients had concurrent pneumonia. The most common intravenous antibiotics given were cefoperazone plus sulbactam, teicoplanin, and meropenem, while most common antifungals given were caspofungin and voriconazole. The patient with Candidemia underwent surgical removal of vegetation as advised by a cardiologist. Histopathological examination and staining of the excised vegetation of this patient revealed Cryptococcus species. 6 (60%) patients developed congestive cardiac failure. 4(40%) died within 4 weeks of diagnosis of endocarditis, out of which 3 were culture-negative endocarditis.

In our case series, none of the blood cultures grew gram-positive bacteria and an increased proportion of culture-negative endocarditis was noted. The mortality is high in patients of cancer with endocarditis.