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Infective endocarditis in childhood
Insights
Infective endocarditis in children, often linked to structural heart disease, is primarily caused by streptococci and staphylococci. Outcomes vary by organism, with Staphylococcus aureus infections having a higher mortality rate.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves, particularly in children with underlying structural heart disease.
- Understanding the epidemiology and outcomes of pediatric IE is crucial for timely diagnosis and management.
Purpose of the Study:
- To describe the clinical characteristics, causative organisms, and outcomes of infective endocarditis in children.
- To identify risk factors and prognostic indicators for pediatric IE.
Main Methods:
- Retrospective review of 37 pediatric cases of infective endocarditis diagnosed between 1971 and 1983.
- Analysis of patient demographics, pre-existing conditions, identified pathogens, treatment, and clinical outcomes.
Main Results:
- Structural heart disease was present in 95% of cases; 15 children had cyanotic congenital heart disease, 11 with prior shunts.
- Streptococci (43%) and staphylococci (27%) were the most common pathogens identified via blood culture.
- The overall mortality rate was 13.5%, with higher mortality in Staphylococcus aureus infections (40%) compared to Streptococcus viridans (0%).
- Survivors experienced significant complications, including valve replacement (4) and central nervous system issues (3).
Conclusions:
- Pediatric infective endocarditis predominantly affects children with pre-existing heart conditions.
- Prompt diagnosis and appropriate antimicrobial therapy are essential, considering the specific causative organisms and their sensitivities.
- The study highlights the need for vigilance in managing IE, particularly in high-risk pediatric populations.
Abstract:
A total of 37 cases of infective endocarditis, in children aged two days to 13 years, were seen from 1971 to 1983 at the Children's Hospital, Camperdown. Structural heart disease was known to preexist in 95%. Cyanotic congenital heart disease was present in 15 children, of whom 11 had been palliated by a systemic-to-pulmonary artery shunt. In five children, there was infection of a prosthetic valve. Identifiable precipitants of infection were rare. In particular, no child had had a preceding dental procedure within three months, while only 19% had had recent cardiac surgery. Organisms were identified by blood culture in 92%, the majority being streptococci (43% of cases) and staphylococci (27% of cases). While 59% of all organisms were penicillin sensitive, six of the seven early postoperative children were infected with organisms not sensitive to antibiotics, given for wound infection prophylaxis in the perioperative period. The overall death rate was 13.5%. Of the children infected with Staphylococcus aureus, 40% died, while no child with Streptococcus viridans endocarditis died. Of the survivors, four needed urgent valve replacement, and three had major central nervous system complications. Using these figures, a current profile of patients with infective endocarditis is presented.