Original article
Infective Endocarditis in the Pediatric Patient: A 60-Year Single-Institution Review

https://doi.org/10.1016/j.mayocp.2012.02.023Get rights and content

Abstract

Objective

To determine the epidemiology of infective endocarditis (IE) presenting in pediatric patients during a 60-year period at our institution.

Patients and Methods

In this retrospective medical record review, we extracted demographic characteristics, diagnostic variables, and outcomes for patients less than 20 years of age diagnosed with IE from January 1, 1980, to June 30, 2011. We compared this cohort with a previously reported cohort of pediatric patients with IE from our institution diagnosed from 1950 to 1979.

Results

We identified 47 patients (24 males; mean ± SD age at diagnosis, 12.3±5.5 years [range, 1 day to 18.9 years]) who had 53 episodes of IE. The most common isolated organisms were viridans streptococci (17 of 53 episodes [32%]) and Staphylococcus aureus (12 of 53 episodes [23%]). Of the 47 patients, 36 (77%) had congenital heart disease, 24 of whom had cardiac surgery before their first episode of IE (mean ± SD time to IE diagnosis after surgery, 4.2±3.2 years [range, 64 days to 11.3 years]). Fourteen patients (30%) required valve replacement because of valvular IE, and 16 (34%) had complications, including mycotic aneurysm, myocardial abscess, or emboli. Vegetations were identified using echocardiography in 37 of the 53 unique episodes of IE (70%). Endocarditis-related mortality occurred in 1 patient. Compared with the historical (1950-1979) cohort, there were no differences in patient demographic characteristics, history of congenital heart disease, or infecting organisms. One-year mortality was significantly lower in the modern cohort (4%) compared with the historical cohort (38%) (P<.001).

Conclusion

Most pediatric episodes of IE occur in patients with congenital heart disease. Mortality due to endocarditis has decreased in the modern era.

Section snippets

Patients and Methods

In this institutional review board–approved study, we searched the Mayo Clinic Division of Infectious Diseases endocarditis database for any patient younger than 20 years diagnosed with IE between January 1,1980, and June 30, 2011. We reviewed all potential cases to confirm that they met the modified Duke criteria for the diagnosis of IE.7 Extracted variables included patient demographic characteristics, infecting organism, history of CHD, prior cardiac surgery, morbidity, mortality, previous

Statistical Analyses

Data were analyzed using JMP 7.0 statistical software (SAS Institute Inc, Cary, NC). All continuous variables were reported as mean ± SD. Proportions were analyzed and compared using the Fisher exact test. Means were analyzed using the independent group t test for means. A 2-sided P value of less than .05 was considered statistically significant.

Demographic Characteristics and Cardiac History

During the 60-year study period (1950-2011) encompassing the 2 cohorts, 97 pediatric patients with IE were seen at our institution. These 97 patients were diagnosed with a total of 103 unique cases of IE. Patient demographic characteristics for both cohorts are shown in Table 1. There were no statistically significant differences for gender, age, and history of CHD. The most common time of presentation in both cohorts was in the teenage years. In cohort 1, 20 of 50 diagnosed episodes IE (40%)

Discussion

Infective endocarditis is rare in the pediatric population but can cause significant morbidity and mortality, particularly in patients with CHD. We report a comprehensive review of IE cases seen at our institution during a 60-year period.

Conclusion

Infective endocarditis continues to be rare in the pediatric population, and most cases now occur in patients with complex CHD rather than the isolated VSD that predominated earlier cohorts. Mortality related to endocarditis is significantly lower in the modern era. The most commonly diagnosed pathogens in pediatric IE have remained consistent throughout the 60 years of our study. Unusual pathogens are now more common in patients with CHD. Modern echocardiographic techniques facilitate the

References (15)

  • S.M. Awadallah et al.

    The changing pattern of infective endocarditis in childhood

    Am J Cardiol

    (1991)
  • L. Saiman et al.

    Pediatric infective endocarditis in the modern era

    J Pediatr

    (1993)
  • M.D. Day et al.

    Characteristics of children hospitalized with infective endocarditis

    Circulation

    (2009)
  • W. Knirsch et al.

    Infective endocarditis in congenital heart disease

    Eur J Pediatr

    (2011)
  • P. Ferrieri et al.

    Unique features of infective endocarditis in childhood

    Circulation

    (2002)
  • L.B. Rosenthal et al.

    The changing epidemiology of pediatric endocarditis at a children's hospital over seven decades

    Pediatr Cardiol

    (2010)
  • W. Wilson et al.

    Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group

    Circulation

    (2007)
There are more references available in the full text version of this article.

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