Infective endocarditis in Arkansan children from 1990 through 2002
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Published on: February 9, 2011
Keith Coward1, Nancy Tucker, Toni Darville
1Department of Pediatrics, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, USA.
Insights
Pediatric infective endocarditis (IE) risk is rising. While pathogens and outcomes remain similar, complications decreased, though Staphylococcus aureus still poses risks.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Medical Informatics
Background:
- Medical and surgical advancements increase endocarditis risk in children.
- Epidemiology, pathogens, and outcomes of pediatric infective endocarditis (IE) may have changed.
- Understanding current trends in pediatric IE is crucial.
Purpose of the Study:
- To review the epidemiology, pathogens, and outcomes of infective endocarditis in pediatric patients.
- To identify changes in IE presentation and management over a decade.
- To assess the impact of risk factors and diagnostic methods on IE outcomes.
Main Methods:
- Retrospective review of medical records from Arkansas Children's Hospital (1990-2002).
- Inclusion criteria based on diagnostic standards for infective endocarditis.
- Data collected included demographics, clinical findings, echocardiogram results, and microbiology.
Main Results:
- 57 pediatric patients with IE were identified; congenital heart disease was the primary risk factor.
- Echocardiograms detected vegetations in 67%, with lower sensitivity in complex cyanotic heart disease.
- Streptococci and Staphylococcus aureus were common pathogens, with enterococci predominant in infants; complication rates decreased, but S. aureus remained linked to higher morbidity.
Conclusions:
- Infective endocarditis remains a significant pediatric challenge.
- Pathogen prevalence and outcomes have shown minimal change in the past decade.
- Reduced complication rates were observed, but S. aureus continues to be a concerning pathogen.
Background:
Recent medical and surgical advances have increased the potential risk of endocarditis. Epidemiology, pathogens, morbidity and/or mortality may have evolved in the past decade in pediatric patients diagnosed with endocarditis.
Methods:
Retrospective reviews of medical records from Arkansas Children's Hospital were done to identify patients with infective endocarditis from January 1990 through December 2002. Basic demographic and clinical data were gathered and reviewed.
Results:
Of 76 patients identified, 57 were included based on diagnostic criteria. Congenital heart disease with (56%) and without (25%) correction were the most common risk factors. Echocardiograms revealed vegetations in 67%. Echocardiograms remain relatively deficient in patients with complex cyanotic heart disease (50% positive) vs. those with normal anatomy (83% positive). Streptococci (30%) and Staphylococcus aureus (21%) were the most common organisms identified overall; however, we observed a predominance of enterococci in infants <2 years of age (41%). Our study revealed a reduced rate of complications, especially of the central nervous system (7% vs. 25 and 33% in prior studies); however, our rate of S. aureus was lower (21% vs. 32 and 39%), and this pathogen continues to be associated with a higher incidence of complications.
Conclusions:
Infective endocarditis continues to present a difficult challenge in pediatrics; its associated pathogens and outcomes have changed little in the past decade.
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