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Pediatric infective endocarditis: Has Staphylococcus aureus overtaken viridans group streptococci as the predominant
Aisha Alshammary1, Marilou Hervas-Malo, Joan L Robinson
1Division of Infectious Diseases, Department of Pediatrics and Stollery Children's Hospital, University of Alberta, Edmonton, Alberta.
Insights
Staphylococcus aureus is increasingly a common cause of infective endocarditis in children, potentially surpassing Viridans group streptococci. Congenital heart disease remains a key risk factor for pediatric infective endocarditis.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Viridans group streptococci (VGS) were historically the primary cause of infective endocarditis (IE) in children.
- Advances in cardiac surgery and central venous catheter use may be shifting IE epidemiology in pediatric populations.
Purpose of the Study:
- To investigate changes in the etiological agents of pediatric infective endocarditis (IE) over time.
- To identify the predominant pathogens causing IE in children at a major pediatric hospital.
Main Methods:
- A retrospective chart review of pediatric IE cases (under 17 years) was conducted from 1985-2004.
- A comprehensive literature review was performed to analyze trends in pediatric IE etiological agents.
Main Results:
- Staphylococcus aureus (S. aureus) was identified as the leading cause of IE in this cohort (n=16), followed by other streptococci (n=8) and VGS (n=5).
- Congenital heart disease was present in 75% of pediatric IE cases.
- Literature review suggests a rising trend of S. aureus as the predominant IE pathogen in pediatric case series.
Conclusions:
- Congenital heart disease remains the principal risk factor for pediatric IE.
- Further population-based studies are needed to confirm if S. aureus has definitively replaced VGS as the most common pathogen in pediatric IE.
Background:
Viridans group streptococci (VGS) have traditionally been the most common etiological agents of infective endocarditis (IE). Advances in cardiovascular surgery and the increasing use of long-term central venous catheters may have altered the epidemiology of pediatric IE.
Methods:
A chart review of children younger than 17 years of age with IE was completed at the Stollery Children's Hospital (Edmonton, Alberta) between 1985 and 2004. The literature was reviewed to look for changes over time in the most common etiological agents of pediatric IE.
Results:
There were 31 cases of definite IE and nine cases of possible IE at the Stollery Children's Hospital, 19 of which were nosocomial. Thirty cases (75%) had congenital heart disease. The etiological agents were Staphylocccus aureus (n=16), VGS (n=5), coagulase-negative staphylococci (n=3), enterococcus (n=3), other streptococci (n=8), Enterobacter cloacae (n=1) and Stenotrophomonas maltophilia (n=1), while three cases were culture negative. Two deaths were due to S aureus IE. Review of the literature identified an increasing number of case series in which S aureus was the predominant etiological agent, but VGS still predominated in some recent series.
Conclusion:
Congenital heart disease remains the primary risk factor for pediatric IE. Prospective population-based studies are required to determine whether S aureus has become the predominant pathogen.
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