Infective Endocarditis in Children With Congenital Heart Disease

Abstract

We sought to address these questions in patients with CHD by determining the cumulative incidence and predictors for the development of IE in a large population-based cohort of affected children. Methods Data SourcesQuebec is Canada's second most populated province with nearly 8 million inhabitants.15 A unique healthcare number is assigned Background-The American Heart Association guidelines for prevention of infective endocarditis (IE) in 2007 reduced the groups of congenital heart disease (CHD) patients for whom antibiotic prophylaxis was indicated. The evidence base in CHD patients is limited. We sought to determine the risk of IE in children with CHD. Methods and Results-We performed a population-based analysis to determine the cumulative incidence and predictors of IE in children (0-18 years) with CHD by the use of the Quebec CHD Database from 1988 to 2010. In 47 518 children with CHD followed for 458 109 patient-years, 185 cases of IE were observed. Cumulative incidence of IE was estimated in the subset of 34 279 children with CHD followed since birth, in whom the risk of IE up to 18 years of age was 6.1/1000 children (95% confidence interval, 5.0-7.5). In a nested case-control analysis, the following CHD lesions were at highest risk of IE in comparison with atrial septal defects (adjusted rate ratio, 95% confidence interval): cyanotic CHD (6.44, 3.95-10.50), endocardial cushion defects (5.47, 2.89-10.36), and left-sided lesions (1.88, 1.01-3.49). Cardiac surgery within 6 months (5.34, 2.49-11.43) and an age of <3 years (3.53, 2.51-4.96; reference, ages 6-18) also conferred an elevated risk of IE. Conclusions-In a large population-based cohort of children with CHD, we documented the cumulative incidence of IE and associated factors. These findings help identify groups of patients who are at the highest risk of developing IE.

Endocarditis in Congenital Heart Disease

“…Importantly, as expected, the risk of IE varied markedly across the CHD lesions in the study by Rushani et al 8 However, the infrequency of IE prevented investigation of CHD lesions individually. CHD lesions were grouped into categories of comparable IE risk, but not all constituent lesions of the group shared identical IE susceptibility.…”

2015 ESC Guidelines for the management of infective endocarditis

“…IZW występuje rzadziej u dzieci (0,04% na rok) niż u dorosłych z CHD (0,1% na rok) [444,445]. Stwierdzany odsetek pacjentów z CHD w populacji chorych z IZW różni się znacznie (prawdopodobnie na skutek błędu wynikającego z doboru grupy) i wynosi 2-60% [446][447][448][449][450], ze zgodnie podawaną przez różne źródła niewielką przewagą mężczyzn [443,451,452].…”

Infective Endocarditis in Childhood: 2015 Update

“…Although the reported hospitalization rates for IE vary considerably among published series, both the overall frequency of endocarditis among children and a shift toward those with previous cardiac surgery appear to have increased in recent years in some reports. [5][6][7][8] This may be related to improved survival among children who are at risk for endocarditis, such as those with CHD (with or without surgery) and hospitalized newborn infants.…”

“…Furthermore, factors often associated with IE in adults, such as intravenous drug abuse and degenerative heart disease, are not common predisposing factors in children. [7][8][9][10][11] …”