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.
Abbreviations and Acronyms:
CHD (congenital heart disease), IE (infective endocarditis), VSD (ventricular septal defect)To read this article in full you will need to make a payment
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© 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
