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Pediatric infective endocarditis in the modern era
L Saiman1, A Prince, W M Gersony
1Department of Pediatrics, Columbia Presbyterian Medical Center, New York, New York 10032.
The Journal of Pediatrics
|June 1, 1993
Summary
Pediatric endocarditis (heart valve infection) has changed, with shifts in risk factors and common pathogens like Staphylococcus aureus. Early diagnosis and treatment remain critical for improving outcomes in children with heart conditions.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Endocarditis in children presents unique challenges compared to adults.
- Understanding evolving trends in pediatric endocarditis is crucial for effective management.
- Previous studies focused on earlier epidemiological periods.
Purpose of the Study:
- To analyze changes in pediatric endocarditis over a 15-year period (1977-1992).
- To identify shifts in risk factors, causative pathogens, diagnostic methods, and patient outcomes.
- To compare current findings with historical data from the 1970s and early 1980s.
Main Methods:
- Retrospective review of 62 pediatric endocarditis cases.
- Comparison of data with previous case series from the 1970s and early 1980s.
- Analysis of clinical data, including underlying conditions, pathogens, diagnostic imaging (echocardiography), and treatment outcomes.
Main Results:
- Complex congenital heart disease and unrepaired ventricular septal defects were common underlying conditions.
- Staphylococcus aureus was the most frequent pathogen, associated with increased central nervous system complications and surgical needs.
- Hospital-acquired endocarditis was noted in children with central venous catheters, including premature infants; fungal endocarditis had a high mortality rate (67%).
Conclusions:
- Pediatric endocarditis epidemiology has evolved, with changes in susceptible populations and risk factors.
- Staphylococcus aureus is a significant pathogen, necessitating vigilance for complications.
- Despite advances, endocarditis remains a serious condition in children, with a 11% overall mortality rate and diagnostic challenges in some severe cases.