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[Trends in pediatric infective endocarditis in a tertiary pediatric center in Israel]
Daphna Marom1, Einat Birk, Shai Ashkenazi
1Department of Pediatrics A, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. dmarom@clalit.org.il
Insights
Pediatric infective endocarditis (IE) now affects younger children, often with non-cardiac conditions. The causes are shifting, with fewer cases from viridans streptococci and more from Candida spp. and coagulase-negative staphylococci.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Context:
- Pediatric infective endocarditis (IE) characteristics are evolving.
- Understanding these changes is crucial for effective management.
- Previous studies highlight shifts in causative agents and patient demographics.
Purpose:
- To analyze trends in pediatric infective endocarditis (IE) over a 25-year period.
- To compare epidemiological and clinical features of IE between two distinct timeframes (1980-1991 and 1992-2004).
- To identify changes in causative microorganisms and patient risk factors.
Summary:
- The study observed a significant decrease in the mean age of pediatric IE patients and a reduction in congenital heart defects as a predisposing factor.
- There was a notable increase in underlying non-cardiac diseases and a rise in surgical interventions and mortality.
- Causative agents shifted from predominantly viridans streptococci to include a greater proportion of Candida spp. and coagulase-negative staphylococci.
Impact:
- Findings indicate a shift in the profile of pediatric IE, increasingly affecting younger children with complex non-cardiac comorbidities.
- The changing microbial landscape necessitates re-evaluation of diagnostic and therapeutic strategies for pediatric IE.
- These trends have implications for clinical practice, potentially influencing treatment protocols and resource allocation in pediatric infectious disease and cardiology.
Introduction:
The characteristics of pediatric infective endocarditis (IE) are continuously changing.
Objectives:
To describe trends in pediatric IE over a period of 25 years.
Study Methods:
Children (< 18 years old] treated at Schneider Children's Medical Center during 1992-2004 who met Duke criteria for definite or possible IE were included in the study. Demographic, clinical and laboratory data were collected and compared to data gathered during 1980-1991.
Results:
Compared to 1980-1991, during 1992-2004 we noted a decrease in the mean age from 6.5 to 4 years and in the incidence of congenital heart defects from 96% to 61% (p = 0.001). Incidence of significant underlying diseases and non-cardiac predisposing factors rose from 4% to 43%. Significantly Less children presented with fever, splenomegaly and murmur during 1992-2004; a 4-fold increase in surgical intervention [p = 0.024) and a 3-fold increase in mortality p = 0.257 were observed. Viridans streptococci (37.5%), Staphylococcus aureus (20.8%) and gram-negative bacilli 2.5%] caused most of IE during 1980-1992, whereas viridians streptococci (19.1%), Candida spp (17%), S. aureus (17%) and coagulase-negative staphylococci (12.8%) were the common causes during 1992-2004.
Conclusions:
Considerable changes in pediatric IE were observed.
Discussion And Summary:
Pediatric IE became an infection of young children, especially those with significant noncardiac underlying diseases. It is less commonly caused by viridans streptococci and is increasingly caused by Candida spp and coagulase-negative staphylococci. These trends may affect the management of pediatric IE.
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