Despite recent advances in diagnosis and treatment, Infective endocarditis remains a serious disease with high morbidity and mortality. Its profile has evolved continuously in developed countries; however in developing countries,only few data have been available during the last years Although several studies have evaluated possible predictors of mortality in patients with IE, recent reports from Tunisia are scarce.

The aim of this study is to outline recent changes in the profile of native infective endocarditis (NIE) in a tertiary care hospital in Tunisia over the last10 years and to determine predictors of outcome.

We gathered retrospectively the data of 110 patients who fulfilled the modified Duke's criteria for native IE between the period 2007–2017. The logistic regression model was used to identify predictive factors for death.

The mean age of patients was 39.2±14 years, a male predominance was noted. Rheumatic heart disease was the predominant underlying heart condition (92%). The infective agent was identified in 40. 9% of cases, the most frequent causative agents were streptococci (46.6%), followed by staphylococci (42.2%). Echocardiography showed vegetations in 90% of cases, abscesses in (12.7%) and valvular mutilation in 21%. Complication was dominated by heart failure in 36% of patients. Surgery was performed during the acute phase of the IE in 29% of cases. The overall in-hospital mortality was 21.8%. On multivariate analysis, staphylococci infection, heart failure, neurological complications and abscesses were predictors of inhospital mortality,

NIE remains a severe disease affecting the young population in Tunisia, rheumatic heart disease continues to be the most common underlying heart condition, and streptococci were the major causative agents, its prognosis is still dark with high rate of mortality.