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Published on: January 7, 2019
[New trends in pediatric endocarditis]
A Carceller1, M H Lebel, G Larose
1Servicio de Pediatría, Departamento de Pediatría, CHU Sainte-Justine, Université de Montréal, Québec, Canadá. ana_carceller@ssss.gouv.qc.ca
Insights
Pediatric endocarditis incidence increased, with higher risks for children with central catheters or immunodeficiency. However, significant reductions in morbidity and mortality were observed between 1960-1985 and 1986-2000.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Epidemiology
Context:
- Endocarditis in children presents unique challenges, often linked to congenital heart disease or invasive procedures.
- Understanding trends in pediatric endocarditis is crucial for effective management and prevention strategies.
Purpose:
- To evaluate the epidemiology, etiology, and outcomes of infective endocarditis in pediatric patients.
- To compare recent trends (1986-2000) with historical data (1960-1985) to identify changes in incidence, risk factors, and outcomes.
Summary:
- A cohort study of 56 pediatric patients (1986-2000) revealed an increased incidence of endocarditis compared to 1960-1985.
- Congenital heart disease was the most common underlying condition. Streptococci and Staphylococci were the primary pathogens. Central catheters and vascular prostheses were noted risk factors.
- Morbidity decreased from 85.7% to 46.4%, and mortality decreased from 27% to 12.5% over the study periods.
Impact:
- The study highlights an increased risk of endocarditis in children with central catheters and underlying immunodeficiency.
- Healthy children with endocarditis face a higher risk of complications.
- Significant improvements in morbidity and mortality underscore advancements in pediatric endocarditis care.
Objectives:
To evaluate the epidemiology, etiology and outcome of endocarditis in a cohort of pediatric patients and to compare the main characteristics with our previous experience.
Material And Methods:
Patients aged less than 18 years of age diagnosed with endocarditis at the Sainte-Justine Hospital, University of Montreal between 1-1986 and 12-2000 were studied. The recent case series was compared with our previous experience from 1960-1985.
Results:
Fifty-six children with endocarditis were included in the 1986-2000 series: 35 children with congenital heart disease, 15 with serious underlying disease and six healthy children. The mean age was 7 years and 10 months. Fifty-four percent of the patients were boys. The incidence of endocarditis increased from 1.5 cases/year in the 1986-2000 series to 4 cases/year in the 1986-2000 series. In the 1986-2000 series, 10 (17.9 %) patients had a central catheter. Sixteen (28.6 %) patients had a vascular prosthesis. Blood cultures were positive in 50 patients (89 %): Streptococci were found in 48 % of the patients and Staphylococci in 34 %. Echocardiography was positive in 36 of 55 patients (65.4 %). All children were treated with intravenous antibiotics for a mean of 43 +/- 15 days. There were no recurrences. Significant morbidity developed in 26 patients (46 %). Embolic phenomena were seen in 11 children (20 %). Twelve patients (21 %) needed surgery. Of the six healthy children, five developed complications. Overall, seven children (12.5 %) died; all were older than 6 years of age. Comparing our experience from 1960-1985 with that from 1986-2000 revealed that morbidity decreased from 85.7 % to 46.4 % and mortality decreased from 27 % to 12.5 %.
Conclusions:
Physicians must recognize that children with underlying immunodeficiency and those with central catheters have an increased risk of endocarditis. Healthy children with endocarditis have a greater risk of complications. Morbidity and mortality due to endocarditis has diminished considerably in recent years.
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