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Background : Infective Endocarditis(IE) remains a serious disease affecting the population in the Developing Countries.objectives: The aim of the study was to describe the epidemiological, laboratory, and echocardiographic aspects of IE in a Tunisian cardiology department and to identify the predictors of in hospital mortality.Materials and methods: Our study is retrospective enrolling 297 patients, hospitalized in our institution between January 2001 and January 2010 for infective endocarditis. according to the modified DUKE criteria. Demographic, clinical, laboratory, and echocardiographic characteristics were examined.Results: The Mean age was 41.45+-18.17 years. The mean diagnosis delay was 9.34 days. Rheumatic heart disease (RHD) was the predominant (40.5%) underlying heart condition. Diagnosis was definite in 48.5% of cases. Left-sided native valve IE, left-sided prosthetic valve IE, right-sided IE were noted respectively in 53.6% cases, in 31 % cases, in 10.4 % cases. Device-related IE is noted in 5 % cases. Echocardiographic findings showed that vegetations were detected in more than 53.7% of cases. Vegetation size>15 mm was found in 17.1%. Abscess was noted in 5.4 % of cases. Dehiscence of a prosthetic valve was revealed in 4.4 % of patients. Fistula and perforation were respectively detected in 2.3% and 7% of cases.In 155 cases (52%), blood cultures remained negative. Serology was positive in 12 cases. Causative microorganisms were mainly Streptococci (n = 48) and Staphylococci (n = 32). Surgery was indicated in 49 % cases. Overall mortality was 16.1 %. On multivariate analysis: RHD (P=0.001), prosthetic valve IE (P=0.032) and congestive heart failure (p = 0.0001) were predictive of in-hospital mortality.Conclusion: Rheumatic heart disease remains the most common underlying heart disease for infective Endocarditis in Tunisia. Despite progress in therapeutic modalities, IE remains very serious condition carrying high mortality rates.