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Infective Endocarditis in Children in Italy from 2000 to 2015
Susanna Esposito1, Alessandra Mayer1, Andrzej Krzysztofiak2
1a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy.
Insights
Pediatric infective endocarditis (IE) in Italy shows evolving trends, with Staphylococcus aureus emerging as a key pathogen, even in children without prior heart conditions. Treatment approaches for pediatric IE remain highly variable.
Area of Science:
- Pediatric Infectious Diseases
- Cardiology
- Microbiology
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Understanding pediatric IE epidemiology is crucial for targeted interventions.
- The Italian Society for Pediatric Infectious Diseases established a registry to track IE cases in children.
Purpose of the Study:
- To analyze the characteristics and outcomes of pediatric infective endocarditis in Italy.
- To identify common pathogens and risk factors associated with IE in children.
- To describe the therapeutic approaches and recovery rates for pediatric IE.
Main Methods:
- A cross-sectional survey of pediatric patients hospitalized with IE.
- Data collected from January 1, 2000, to June 30, 2015.
- Analysis of patient demographics, causative pathogens, predisposing conditions, and treatment outcomes.
Main Results:
- 47 episodes of pediatric IE were recorded over 15 years.
- Viridans Streptococci were common in patients with cardiac conditions; Staphylococcus aureus predominated in those without.
- Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 85.7% of S. aureus isolates.
- Most patients recovered without complications, irrespective of predisposing factors.
Conclusions:
- Pediatric IE can occur in children without prior cardiac conditions.
- MRSA has emerged as a significant causative agent in pediatric IE.
- Therapeutic strategies for pediatric IE exhibit considerable variability.
Objective:
The Italian Society for Pediatric Infectious Diseases created a registry on children with infective endocarditis (IE) hospitalized in Italy.
Methods:
A cross-sectional survey was conducted on patients hospitalized due to IE in Italian paediatric wards between January 1, 2000, and June 30, 2015.
Results:
Over the 15-year study period, 47 IE episodes were observed (19 males; age range, 2-17 years). Viridans Streptococci were the most common pathogens among patients with predisposing cardiac conditions and Staphylococcus aureus among those without (37.9% vs. 5.5%, p = 0.018, and 6.9% vs. 27.8%, p = 0.089, respectively). Six of the 7 (85.7%) S. aureus strains were methicillin-resistant. The majority of patients with and without predisposing cardiac conditions recovered without any complications.
Conclusion:
In Italy, paediatric IE develops without any previous predisposing factors in a number of children, methicillin-resistant S. aureus has emerged as a common causative agent and the therapeutic approach is extremely variable.
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