Infective endocarditis in childhood: a single-centre experience of 26 years

Abstract

The aim of this study was to present the clinical and microbiological characteristics of patients with infective endocarditis. A retrospective evaluation was made of patients diagnosed with infective endocarditis between 1995 and 2021. The clinical and laboratory characteristics of the patients were recorded together with conditions constituting a risk for the development of endocarditis, treatment, and surgical outcomes. Evaluation was made of 68 patients with a mean age of 7.3 years (3 months–17 years), diagnosed with infective endocarditis. An underlying cause of CHD was determined in 47 (69%) patients and rheumatic valve disease in 3 (4.4%). There was no structural heart disease in 18 (26%) patients of whom 13 of them had other risk factors. A causative organism was found in 41 (60%) cases, and the microorganism most often determined was viridans group streptococcus. No difference was determined between the patients diagnosed before and after 2007 in respect of the frequency of viridans streptococcus (p > 0.05). Septic emboli were seen in 18 (26%) patients, of which 17 required surgical treatments. In 5 of 11 (16.6%) patients with mortality, the agent was S. aureus. Of the total 28 (41%) patients were evaluated as hospital-acquired endocarditis. The most frequently determined agents in this group were staphylococcus epidermidis and S. aureus. Although CHDs continue to be the greatest risk factor for endocarditis, there is an increasing frequency of endocarditis in patients with no structural heart disease. Mortality rates are still high in infective endocarditis, especially in S. aureus endocarditis.

Epidemiological, Bacteriological, and Evolutive Features of Children Hospitalized for Infective Endocarditis in a Tertiary Tunisian Pediatric Department

“…In our study, similar to others, IE was found to be rare in infancy but frequently observed in children older than 2–3 years. The female predominance observed in our analysis contrasts with the similar frequency in male and female patients reported in most studies [ 4 , 5 , 12 ].…”

“…Delay in the surgical management of these children has led to the emergence of severe complications such as IE before complete surgical repair. Ventricular septal defect was the most common CHD complicated by IE in our study, consistent with findings in most published studies [ 5 , 10 ]. IE exhibits a bimodal distribution with peaks in infancy and adolescence [ 11 ].…”

“…In our study, the proportion of negative blood cultures was estimated at 47.1 %, which is higher compared to other studies. Notably, culture-negative IE accounted for 8 %–40 % of children clinically diagnosed with IE and negative blood cultures in several publications [ 1 , 5 , 15 ]. The elevated proportion of negative-culture IE in our study may be attributed to two hypotheses: firstly, the liberal prescription of antibiotics in febrile children, and secondly, the limited investigations conducted in our bacteriological laboratories.…”