Características clínicas y epidemiológicas de la endocarditis infecciosa en pediatría: 26 años de experiencia/Clinical and epidemiological charasterisitics of infective endocarditis in children: a 26-year experience

• Published in: Acta pediátrica española Vol. 74; no. 3/4; p. 93
• Main Authors: Carreras-Blesa, C, del Villar, M Martínez, Pérez, S Melendo, Casas, E Guijarro, Blasco, P Betrián
• Format: Journal Article
• Language: Spanish
• Published: Madrid Ediciones Mayo 01.03.2016
• Subjects: Cardiovascular disease; Children & youth; Epidemiology; Morbidity; Mortality
• ISSN: 0001-6640; 2014-2986

Infective endocarditis is a rare disease in childhood. Nevertheless, morbimortality rates are still high. The aim of this study is to report the characteristics and clinical followup of our series of patients and to compare them to those reported in the literature. We perform a retrospective study in a third-level Spanish hospital. Patients aged less than 16 years and diagnosed with endocarditis, according to Duke criteria, from 1988 to 2013 were selected. Two periods of time were compared: 1988-2000 and 2001-2013. A total of 44 patients were included (36 pediatric and 8 neonates). The incidence of endocarditis increased from 1/10,000 admissions/year to 3.3/10,000 from one period to the next. Of the total of patients, 63% had some kind of congenital heart disease and up to 45% had undergone previous cardiac surgery. Thirty-one percent of the patients had a central venous catheter. Echocardiography showed vegetations in 82% of the patients. Staphylococcus aureus and Streptococcus viridans were the microorganisms most frequently found in blood cultures. Endocarditis was treated surgically in 29% of cases. The rate of endocarditis-related complications was 56%, being heart failure the most frequent. Mortality rate reached 20%. Of the total of deaths, 55% had mitral involvement and 77% were caused by S. aureus or fungical infection. The majority of patients who develop endocarditis have previous history of congenital heart disease and/or have undergone cardiac surgery. An increase of frequency of endocarditis was observed in premature, or immunodepressed patients, as well as in patients with central vascular catheters or prosthesis. A worse prognosis was observed in patients with mitral involvement and in those infected with fungi or S. aureus.