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Infective endocarditis in children with congenital heart disease: cumulative incidence and predictors
Dinela Rushani1, Jay S Kaufman, Raluca Ionescu-Ittu
1Department of Epidemiology, Biostatistics and Occupational Health; McGill University, Montreal, Canada (D.R., J.S.K., R.I.-I., L.P., A.J.M.); Division of Cardiology, Stollery Children's Hospital, Edmonton, Canada (A.S.M.); Division of General Internal Medicine, McGill University Health Center, Montreal, Canada (L.P.); and McGill Adult Unit for Congenital Heart Disease, McGill University Health Center, Montreal, Canada (J.T., A.J.M.).
Insights
Children with congenital heart disease (CHD) face a cumulative risk of infective endocarditis (IE) up to age 18. Certain CHD types, cyanotic heart disease, and early childhood increase this risk, informing targeted prevention strategies.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Public Health
Background:
- 2007 American Heart Association guidelines narrowed antibiotic prophylaxis for infective endocarditis (IE) in congenital heart disease (CHD) patients.
- Limited evidence exists regarding IE risk specifically within pediatric CHD populations.
- This study aimed to quantify the risk of IE in children diagnosed with CHD.
Purpose of the Study:
- To determine the cumulative incidence of infective endocarditis (IE) in children with congenital heart disease (CHD).
- To identify specific predictors and risk factors for IE development in this pediatric cohort.
- To inform updated guidelines for IE prevention in children with CHD.
Main Methods:
- Population-based cohort study utilizing the Quebec CHD Database (1988-2010).
- Analysis included 47,518 children (0-18 years) with CHD, with 458,109 patient-years of follow-up.
- Nested case-control analysis identified risk factors for IE.
Main Results:
- The cumulative incidence of IE up to age 18 was 6.1 per 1000 children with CHD.
- Highest IE risk associated with cyanotic CHD (RR 6.44), endocardial cushion defects (RR 5.47), and left-sided lesions (RR 1.88).
- Recent cardiac surgery (within 6 months, RR 5.34) and younger age (<3 years, RR 3.53) significantly increased IE risk.
Conclusions:
- This large population-based study quantifies the cumulative incidence of IE in children with CHD.
- Identified high-risk CHD subtypes and clinical factors (early childhood, recent surgery) associated with increased IE risk.
- Findings aid in identifying pediatric CHD patients who may benefit from targeted IE prevention strategies.
Background:
The American Heart Association guidelines for prevention of infective endocarditis (IE) in 2007 reduced the groups of congenital heart disease (CHD) patients for whom antibiotic prophylaxis was indicated. The evidence base in CHD patients is limited. We sought to determine the risk of IE in children with CHD.
Methods And Results:
We performed a population-based analysis to determine the cumulative incidence and predictors of IE in children (0-18 years) with CHD by the use of the Quebec CHD Database from 1988 to 2010. In 47 518 children with CHD followed for 458 109 patient-years, 185 cases of IE were observed. Cumulative incidence of IE was estimated in the subset of 34 279 children with CHD followed since birth, in whom the risk of IE up to 18 years of age was 6.1/1000 children (95% confidence interval, 5.0-7.5). In a nested case-control analysis, the following CHD lesions were at highest risk of IE in comparison with atrial septal defects (adjusted rate ratio, 95% confidence interval): cyanotic CHD (6.44, 3.95-10.50), endocardial cushion defects (5.47, 2.89-10.36), and left-sided lesions (1.88, 1.01-3.49). Cardiac surgery within 6 months (5.34, 2.49-11.43) and an age of <3 years (3.53, 2.51-4.96; reference, ages 6-18) also conferred an elevated risk of IE.
Conclusions:
In a large population-based cohort of children with CHD, we documented the cumulative incidence of IE and associated factors. These findings help identify groups of patients who are at the highest risk of developing IE.
Related Concept Videos
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01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:18Endocarditis III: Medical Management
01:29Endocarditis IV: Nursing Management
01:23Rheumatic Heart Disease I: Introduction
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