Infective endocarditis in the pediatric population: A single-center retrospective study of outcomes and predictors

Infective Endocarditis (IE) continues to pose significant risks for children and adolescents, particularly those with Congenital Heart Disease (CHD). Improved survival among pediatric CHD patients has expanded the population susceptible to IE, especially involving prosthetic materials. This study aims to characterize the clinical features, diagnostic challenges, outcomes and complications of IE in relation to valve type and underlying heart defects in a pediatric population.

We conducted a retrospective review of pediatric IE cases diagnosed using modified Duke criteria from 2013 to 2024 across a specialized cardiac center. Patients were categorized as having Native Valve Endocarditis (NVE) or Prosthetic Valve Endocarditis (PVE). Data included demographics, microbiology, imaging modalities, and complications and outcomes.

95 patients were identified for the analysis. Of the cohort, 62.2% were male, with a median age of 14 years [IQR 7-17]. NVE patients were significantly younger (median 7.8 years) than PVE patients (15.7 years, p < 0.0002). CHD was the leading predisposing factor (88.4%), with right ventricle-pulmonary artery (RV-PA) conduit most commonly affected in PVE (47.7%). Staphylococcus aureus predominated in NVE (30.4%), while Viridans Streptococci were more frequent in PVE (31.1%). Coagulase-negative Staphylococci (CoNS) were exclusively found in the PVE group (23.4% of positive cultures vs 0% in NVE; p = 0.01). Echocardiography identified lesions suspicious for endocarditis less frequently in PVE compared to NVE (67.7% vs. 93.3%, p = 0.007). This was associated with a significantly higher utilization of Cardiac Computed Tomography (p = 0.01) and metabolic imaging (p = 0.03) in PVE cases. Surgical intervention was required in 54.7% of cases, mainly for HF (48.1%), embolic events, or uncontrolled infection. In-hospital mortality was 5.3%.

These data emphasize the continued challenge of IE in children with CHD, particularly after valve implantation, necessitating lengthy hospitalizations. Our findings highlight the importance of tailoring diagnostic and treatment strategies based on valve type (NVE vs PVE) and identifying patient population which may be at higher risk post intervention.

• Pediatric infective endocarditis carries substantial morbidity, particularly in children with congenital heart disease and prosthetic material.

• Valve‑specific clinical patterns show distinct age distribution, microbiology, and imaging sensitivity between native and prosthetic valve endocarditis, identifying pediatric subgroups at higher post‑intervention risk.