Infective endocarditis in pediatric patients in a tertiary care hospital, Pakistan

Abstract

Introduction: Endocarditis is a rare disorder which is associated with significant morbidity & mortality world over especially in the developing countries. The etiology of disease has gradually shifted from Rheumatic heart disease to prosthetic & device associated endocarditis in the developed world. Very little is known about its etiology in Pakistan.Objective: To find out the frequency of disease and organisms leading to endocarditis in children admitted in Rawalpindi Institute of Cardiology.Methods: A retrospective cross sectional study was carried out in indoor pediatric patients at Rawalpindi Institute of Cardiology in Rawalpindi from Jan 1 st till Oct 15 th 2017. Out of 120 clinical suspected patients of endocarditis, only fifty patients fulfilled Modified Dukes Criteria for the diagnosis of endocarditis. Three sets of blood cultures were collected from the patients having fever before the start of antibiotics. Samples were incubated in Bact Alert 3D automated blood culture system (Biomereux France). All indicator positives were subcultured using standard microbiological methods. The blood cultures were followed daily & negative cultures were reported after 7 days of incubation. Echocardiographic findings were taken from patient's clinical record. All the collected quantitative data were analyzed by SPSS 19.0.Results: Endocarditis was diagnosed in 50/120 (41.6%) patients. There were 35 (70%) males & 15 (30%) females. The mean age of patients was 5.5(±1.7) years. The most common presenting complaints were fever, shortness of breath, chest discomfort & cyanotic spells. The common underlying disease associated with endocarditis was Congenital Heart Disease (CHD) (52%) followed by Rheumatic Heart Disease (RHD) (32%). Blood cultures were positive in 16 (32%) patients while in 34 (68%) patients, blood cultures were negative. Coagulase negative Staphylococcus was the most frequently isolated organism 5/16 (31.2%) in our studied patients.