Retrospective studies on pediatric infective endocarditis over 40 years in a mid-west area of China

We have evaluated 106 pediatric cases of infective endocarditis (IE) to elucidate clinical manifestations and pathogenic microorganism profiling of IE in China.

Clinical features, complications, pathogenic microorganisms, diagnosis and treatment of pediatric IE were reviewed in two groups of patients with IE from the different periods of time (group A, 34 cases obtained in the period from 2000 to 2011 and group B, 72 cases obtained in the period from 1964 to 1999).

A total of 106 pediatric patients with a definite diagnosis of IE based on the modified Duke criteria were enrolled and evaluated in this study. By comparing two groups of patients from different time periods, we found that the incidence of rheumatic heart disease was significantly reduced (from 19.4 to 5.9%), whereas congenital heart disease-associated IE had a tendency to increase (from 55.6 to 79.4%). Staphylococcus aureus was detected as the most common pathogenic microorganism, and its involvement tended to increase (from 32.0 to 58.5%), whereas the percentage of infections caused by Streptococcus viridans (8.0%) had not changed. It was interesting to note that the rate of vegetations detected was increased from 50.0 to 67.6% and the incidence of right-sided IE was also increased (from 35.0 to 60.9%). The most common valves involved in recent cases were tricuspid valves (increase from 30.0 to 47.8%), while mitral valve infection was reduced (from 60.0 to 39.1%). Penicillin was still the most commonly used antibiotic for the treatment of IE; the combination of penicillin plus cephalosporin has been recommended more and more recently.

Comparing pediatric IE patients during the past 40 years, we found that the role of rheumatic heart disease as a predisposing factor is diminishing. Pediatric IE is still predominantly caused by staphylococci. The most commonly involved valves are tricuspid valves instead of mitral valves. Gram-positive bacteria showed an increased resistance to penicillin when used alone, and the use of combination treatment with antibiotics is increasing in the area.