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Infective endocarditis in infants and children during the past ten years
S C Chen1, K S Hsieh, Y J Wang
1Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, R.O.C.
Insights
Pediatric infective endocarditis, often linked to heart disease, remains a serious threat. Early diagnosis, effective antibiotic therapy, and timely surgery are crucial for improving survival rates in children.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infective endocarditis (IE) is rare in children but serious, especially in those with congenital heart disease.
- Despite advances in treatment and prophylaxis, IE poses a significant mortality risk across pediatric age groups.
- This study reviews institutional experience with pediatric infective endocarditis.
Purpose of the Study:
- To analyze the clinical characteristics, treatment outcomes, and survival factors of infective endocarditis in a pediatric population.
- To identify risk factors associated with mortality in pediatric IE cases.
Main Methods:
- Retrospective review of clinical and laboratory data from 28 children experiencing 30 episodes of infective endocarditis between July 1984 and June 1993.
- Analysis included patient demographics, cardiac history, microbiological findings, diagnostic imaging, treatment strategies, and outcomes.
Main Results:
- Congenital heart disease was present in 75% of patients; 14% had no underlying cardiac abnormality.
- Streptococcus viridans and Staphylococcus aureus were the most common pathogens identified in positive blood cultures (87% of episodes).
- Echocardiography detected vegetations in 75% of patients. Overall mortality was 21%, with higher rates in infants and those without prior heart conditions.
Conclusions:
- Early diagnosis, appropriate antimicrobial therapy, and prompt surgical intervention are critical for improving patient survival.
- Risk stratification based on age and underlying cardiac status is important for managing pediatric infective endocarditis.
- Aggressive management strategies are necessary to reduce the high mortality associated with infective endocarditis in vulnerable pediatric populations.
Background:
Infective endocarditis occurs infrequently in the general pediatric population, but is often associated in patients with underlying heart disease. Even today it remains a serious threat leading to relevant mortality in all pediatric groups, in spite of better antibiotic treatment and prophylactic measures for endangered persons. This retrospective analysis reports experience here with infective endocarditis in children.
Methods:
The clinical and laboratory findings in 28 children with 30 episodes of infective endocarditis, from July 1984 to June 1993, were reviewed retrospectively.
Results:
Twenty-one children (75 percent) had congenital heart disease, three (11 percent) had rheumatic heart disease and four (14 percent) had no underlying cardiac abnormality prior to presentation. Twenty-six (87 percent) of the 30 episodes had positive blood cultures. The most common organism isolated was streptococcus viridans (14 percent), followed by staphylococcus aureus (7 percent). Echocardiography identified vegetation in 21 of 28 (75 percent) patients. Twenty children were successfully treated medically. Four developed complications requiring surgery, of whom two died. A total of six children (21 percent) died of the disease or its complications. There were a high case fatality rate for children below the age of two years (75 percent), and children without an underlying cardiac abnormality (50 percent).
Conclusions:
It was concluded that patient survival is dependent on several factors which include early diagnosis, appropriate antimicrobial therapy and aggressive surgical intervention.