Infective endocarditis in children and adolescents: a different profile with clinical implications

Area of Science:

• Cardiology
• Infectious Diseases
• Pediatrics

Background:

• Infective endocarditis (IE) is a serious infection affecting heart valves and inner lining.
• Understanding pediatric IE is crucial, as it may present differently than in adults.
• Congenital heart disease (CHD) is a significant factor in pediatric IE cases.

Purpose of the Study:

• To compare the clinical profile and outcomes of pediatric infective endocarditis (IE) with that of adult IE.
• To identify specific characteristics of IE in children and adolescents, particularly in relation to CHD.

Main Methods:

• A prospective, multicenter registry study was conducted across 31 Spanish hospitals.
• Data were collected from 5590 patients diagnosed with IE between 2008 and 2020.
• Patients were categorized into pediatric (<18 years) and adult groups for comparative analysis.

Main Results:

• Pediatric IE (0.1% of cases) was frequently associated with CHD (63.2%), showing a higher prevalence of right-sided IE (46.9%) and pulmonary IE (48.4%).
• Staphylococcus aureus was a more common etiology in pediatric patients (32.7%) compared to adults (22.3%).
• Heart failure was less common in pediatric patients with CHD (9.6%) than in those without (44.4%), though in-hospital mortality was high in both groups (16.3% vs. 25.9%).

Conclusions:

• Pediatric IE is predominantly seen in patients with CHD, characterized by right-sided location and lower heart failure rates compared to non-CHD patients.
• IE in children and adolescents without CHD exhibits a clinical profile more similar to adult IE, including left-sided predominance and acute heart failure as a frequent complication.
• Despite differences in presentation, in-hospital mortality remains a significant concern across all age groups and CHD statuses.