Abstract
Structural heart disease, intravascular catheters, and invasive procedures are predisposing factors for infective endocarditis (IE). Data on IE in children with structurally normal hearts and no predisposing factors are limited. We aim to characterize IE (definite or possible by Duke criteria) in such a subgroup of pediatric patients (age <18 years) who were treated at our medical center. Of 51 events of IE in 50 children, 9 (18 %) had no predisposing factors. These infections were all community-acquired and presented with fever, a newly detected heart murmur, diagnostic echocardiographic findings, and left-sided infection. Clinical course was characterized by acute onset (n = 8 of 9) with a 100 % complication rate (heart failure or embolic phenomena). Emergency cardiac surgery was performed in 7 children (Ross surgery [n = 4], mitral valve replacement [MVR; n = 2], and valve repair [n = 1]). Causative organisms were S. aureus (n = 3), S. pneumoniae (n = 2), H. parainfluenzae (n = 1), and K. kingae (n = 1). In contrast, IE in children with predisposing factors (42 of 51 [82 %]) was frequently health care–associated (30 of 42), right-sided (20 of 42, p = 0.041), and with lower rates of diagnostic echocardiographic findings (28 of 42, p = 0.041), complications (16 of 42, p < 0.001), and surgical intervention (9 of 42, p = 0.002). Causative organisms were mainly viridans streptococci (n = 9), Candida species (n = 8), coagulase-negative staphylococci (n = 6), enteric Gram-negative bacilli (n = 6), S. aureus (n = 5), and K. kingae (n = 3). Mortality was 11 % in both groups. We conclude that pediatric IE in children with and without predisposing factors differs significantly. Due to the acute and complicated course of the latter, high awareness among pediatricians and prompt diagnosis are crucial.
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References
Armstrong ML, DeBoer S, Cetta F (2008) Infective endocarditis after body art: a review of the literature and concerns. J Adolesc Health 43:217–225
Ashkenazi S, Levy O, Blieden L (1997) Trends of childhood infective endocarditis in Israel with emphasis on children under 2 years of age. Pediatr Cardiol 18:419–424
Benito N, Miró JM, de Lazzari E, Cabell CH, del Río A, Altclas J et al (2009) Health care-associated native valve endocarditis: importance of non-nosocomial acquisition. Ann Intern Med 150:586–594
Coward K, Tucker N, Darville T (2003) Infective endocarditis in Arkensan children from 1990 through 2002. Pediatr Infect Dis J 22:1048–1052
Day MD, Gauvreau K, Shulman S, Newburger JW (2009) Characteristics of children hospitalized with infective endocarditis. Circulation 119:865–870
Durack DT, Lukes AS, Bright DK (1994) New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 96:200–209
Ferrieri P, Gewitz MH, Gerber MA, Newberger JW, Dajani AS, Shulman ST et al (2002) Unique features of infective endocarditis in childhood. Pediatrics 109(5):931–943
Giannitsioti E, Skiadas I, Antoniadou A, Tsiodras S, Kanavos K, Triantafyllidi H et al (2007) Nosocomial vs. community acquired-infective endocarditis in Greece: changing epidemiological profile and mortality risk. Clin Microbial Infect 13:763–769
Hill EE, Herijgers P, Claus P, Vanderschueren S, Herregods MC, Peetermans WE (2007) Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. Eur Heart J 28:196–203
Kovarik A, Setina M, Sulda M, Pazderkova P, Mokracek A (2007) Infective endocarditis of the tricuspid valve caused by Staphylococcus aureus after ear piercing. Scand J Infect Dis 39:266–268
Le Guillou S, Casalta JP, Fraisse A, Kreitmann B, Chabrol B, Dubus JC et al (2010) Endocardite infectieuse sur coeur sain chez l’enfant: etude retrospective de 11 cas. Arch Pédiatr 17:1047–1055
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T et al (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infec Dis 30:633–638
Liew WK, Tan TH, Wong KY (2004) Infective endocarditis in childhood: a seven-year experience. Singapore Med J 45(11):525–529
Marom D, Levy I, Gutwein O, Birk E, Ashkenazi S (2011) Healthcare associated vs community-associated infective endocarditris in children. Pediatr Infect Dis J 30:585–588
McDonald Jay R (2009) Acute infective endocarditis. Infect Dis Clin North Am 23:643–664
Millar BC, Moore JE (2004) Antibiotic prophylaxis, body piercing and infective endocarditis. J Antimicrob Chemother 53:123–126
Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS et al (2009) Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century. The international collaboration on endocarditis-prospective cohort study. Arch Intern Med 169:463–473
Nah S-Y, Chung M-H, Park JE, Durey A, Kim M, Lee J-S (2011) Infective endocarditis caused by methicillin resistant Staphylococcus aureus in a young woman after ear piercing: a case report. J Med Case Rep 5:336
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Marom, D., Ashkenazi, S., Samra, Z. et al. Infective Endocarditis in Previously Healthy Children With Structurally Normal Hearts. Pediatr Cardiol 34, 1415–1421 (2013). https://doi.org/10.1007/s00246-013-0665-9
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DOI: https://doi.org/10.1007/s00246-013-0665-9