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Risk factors for infective endocarditis in children with congenital heart diseases - A nationwide population-based
Li-Chuan Sun1, Chih-Cheng Lai2, Cheng-Yi Wang3
1Department of Pediatrics, Cardinal Tien Hospital and School of Medicine, Colloge of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
Insights
Infective endocarditis (IE) risk varies in children with congenital heart disease (CHD). Invasive cardiac procedures increase IE risk, while dental procedures do not, regardless of antibiotic use.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Infective endocarditis (IE) is rare in children, and its epidemiological characteristics in those with congenital heart disease (CHD) are not well understood.
- Understanding IE risk factors in pediatric CHD patients is crucial for prevention and management.
Purpose of the Study:
- To investigate the incidence and epidemiological features of IE in children with CHD.
- To identify specific CHD lesions and invasive procedures associated with an increased risk of IE.
Main Methods:
- A retrospective cohort study of children diagnosed with CHD before age 3 in Taiwan (1997-2005), followed until 2010.
- Data collected included demographics, IE diagnosis, invasive procedures (catheterization, surgeries), and prophylactic antibiotic use for dental procedures.
- Statistical analysis identified risk factors for IE in the CHD population.
Main Results:
- 24,729 children with CHD were analyzed, with 237 diagnosed with IE (incidence: 11.13 per 10,000 person-years).
- Higher IE risk was associated with cyanotic CHD, endocardial cushion defect, left-sided lesions, and ventricular septal defect (VSD).
- Invasive procedures like central venous catheter insertion, cardiac catheterization, and various heart surgeries significantly increased IE risk; dental procedures did not.
Conclusions:
- The risk of IE in children with CHD is significantly influenced by the type of heart defect.
- Invasive cardiac procedures are major risk factors for IE in this population.
- Dental procedures, even with antibiotic prophylaxis, were not associated with increased IE risk.
Background:
Infective endocarditis (IE) is uncommon in childhood. Its associated epidemiological characteristics in patients with congenital heart disease (CHD) remain unclear.
Methods:
The study population included children born in Taiwan during the years 1997 to 2005 who were diagnosed as having CHD before 3years of age. All children were followed up until the end year of 2010, the diagnosis of infective endocarditis, or death. The demographic characteristics of patients with and without IE, the invasive procedures performed during 6months before the index date, the prophylactic antibiotics related to dental procedures, and in-hospital mortality were collected.
Results:
Information of 24,729 children with CHD were retrieved for our analysis and 237 patients with newly diagnosed IE were identified. The incidence rate of IE in all CHD lesions was 11.13 per 10,000person-years. Taking ASD for reference, the following CHD lesions were at risk for IE: cyanotic CHD (adjusted OR, 9.58; 95% confidence interval, 5.38-17.05), endocardial cushion defect (ECD) (8.01; 2.73-23.50), Left-sided lesions (4.36; 1.90-10.01) and VSD (2.93; 1.64-5.23). Patients who underwent procedures have a higher risk of acquiring IE which include central venous catheter (CVC) insertion (3.17; 2.36-4.27), cardiac catheterization (3.74; 2.67-5.22), open-heart surgery (2.47; 1.61-3.77), valve surgery (3.20; 1.70-6.02), and shunt surgery (7.43; 2.36-23.41). However, dental procedures did not increase the risk of IE, irrespective of antibiotic usage.
Conclusions:
The risk of IE varies markedly among CHD lesions in our study. Invasive heart procedures but not dental procedures, are more significantly associated with IE among children with CHD.
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