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Infective endocarditis: 35 years of experience at a children's hospital
J M Martin1, W H Neches, E R Wald
1Department of Pediatrics, University of Pittsburgh School of Medicine, and Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.
Insights
Infective endocarditis in children, often linked to congenital heart disease, presents significant risks. Staphylococcus aureus infections correlate with worse outcomes and higher complication rates.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Clinical Medicine
Background:
- Infective endocarditis (IE) in children is a serious condition often associated with underlying heart abnormalities.
- Congenital heart disease is a major predisposing factor, with many affected children having undergone prior cardiac surgery.
Purpose of the Study:
- To analyze predisposing conditions, clinical presentation, risk factors, bacterial causes, hospital course, and outcomes of infective endocarditis in pediatric patients.
- To identify specific bacterial etiologies and their impact on patient prognosis and treatment requirements.
Main Methods:
- Retrospective analysis of 76 cases of infective endocarditis in 73 pediatric patients treated between 1958 and 1992.
- Review of patient demographics, predisposing conditions, presenting symptoms, bacterial cultures, treatment responses, complications, and survival rates.
Main Results:
- Congenital heart disease was present in 62 patients (85%), with 77% having had previous cardiac surgery.
- Blood cultures remained positive for a mean of 0.7 days after antibiotic initiation, and fever persisted for a mean of 4.28 days; 39% experienced secondary fever.
- Overall survival was 41% without complications, 18% died, and 18% required surgery due to complications. Staphylococcus aureus infections were associated with prolonged fever, secondary fever, and increased need for surgery compared to viridans streptococci.
Conclusions:
- Infective endocarditis in children, particularly those with congenital heart disease, carries a substantial mortality and morbidity risk.
- Staphylococcus aureus is a more virulent pathogen in pediatric infective endocarditis, leading to more severe disease and complications, necessitating prompt and aggressive management.
Abstract:
We review the predisposing conditions, the presenting signs and symptoms, as well as the risk factors and bacterial etiologies in children with infective endocarditis, focusing on hospital course and outcome. We conducted a retrospective analysis of 76 cases of endocarditis in 73 patients occurring at Children's Hospital of Pittsburgh from January 1958 through December 1992. The median age of the patients was 9 years (range, 1 month to 18 years). Predisposing conditions included congenital heart disease (62 patients) and rheumatic heart disease (four patients). Seventy-seven percent of the children with congenital heart disease had undergone cardiac surgery. After therapy with appropriate antibiotics was started, blood cultures for 67 patients (70 episodes of infective endocarditis) remained positive for a mean (+/-SD) of 0.7 +/- 1.41 days, and all patients who presented with fever (75 episodes in 72 patients) remained febrile for a mean (+/-SD) of 4.28 +/- 6.21 days. Secondary fever occurred in 39% of the children. Thirty (41%) of the 73 patients survived without any complications and 13 (18%) died. Fifteen children with complications required surgery. Children with endocarditis caused by Staphylococcus aureus were more likely than those with infection caused by viridans streptococci to have prolonged fever, secondary fever, and/or complications as well to require surgery.