Infective endocarditis in children: A 5 year experience from Al-Zahra Hospital, Isfahan, Iran

Authors

Department of Pediatric, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Considering that there are no regional published data regarding the epidemiologic findings of infective endocarditis (IE) in children, in this study we reviewed the epidemiologic and clinical features and treatment and outcome of children diagnosed with IE at Al-Zahra hospital over a 5-year period.
Materials and Methods: In this retrospective study, medical records of patients (<18 years old) admitted from March 2006 to March 2011 in Al-Zahra Hospital (Pediatrics Infectious or Cardiology Departments) reviewed. The medical files reviewed regarding demographic, clinical, diagnostic (laboratory, microbiological and echocardiographic details) and treatment and outcome details. Obtained data were recorded in a questionnaire. The diagnosis of IE was determined based on Duke criteria.
Results: In this study, 17 patients fulfill the Duke criteria for definite or the possible IE. The most common causes of IE was non-cyanotic heart disease (ventricular septal defect and AS; 64.8%). From cyanotic hearth disease,   Tetralogy of Fallot (TOF) was the most frequent causes (11.8%). In this study, 41% of patients with IE aged < 2 years and 70% aged < 6 years. In this study, 76.5% of patients had a history of congenital heart disease or cardiac surgery. Blood cultures were positive in 10 patients (58.8%). Coagulase-negative staphylococci (23.5%) and Staphylococcus aureus (11.7%) were the most common organisms that cause IE.
Conclusion: It seems that in order to provide a regional comprehensive guideline for appropriate management and prevention of IE related complications further advanced studies with larger sample size and evaluation is recommended.

Keywords

1.
Knirsch W, Nadal D. Infective endocarditis in congenital heart disease. Eur J Pediatr 2011;170:1111-27.  Back to cited text no. 1
    
2.
Ferrieri P, Gewitz MH, Gerber MA, Newburger JW, Dajani AS, Shulman ST, et al. Unique features of infective endocarditis in childhood. Circulation 2002;105:2115-26.  Back to cited text no. 2
    
3.
Lengyel M. Diagnosis, treatment and prevention of infective endocarditis. Orv Hetil 2010;151:613-20.  Back to cited text no. 3
    
4.
Fisher MC. Changing risk factors for pediatric infective endocarditis. Curr Infect Dis Rep 2001;3:333-6.  Back to cited text no. 4
    
5.
Sadiq M, Nazir M, Sheikh SA. Infective endocarditis in children - Incidence, pattern, diagnosis and management in a developing country. Int J Cardiol 2001;78:175-82.  Back to cited text no. 5
    
6.
Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: Guidelines from the American Heart Association: A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736-54.  Back to cited text no. 6
    
7.
Netzer RO, Zollinger E, Seiler C, Cerny A. Infective endocarditis: Clinical spectrum, presentation and outcome. An analysis of 212 cases 1980-1995. Heart 2000;84:25-30.  Back to cited text no. 7
    
8.
Heiro M, Helenius H, Mäkilä S, Hohenthal U, Savunen T, Engblom E, et al. Infective endocarditis in a Finnish teaching hospital: A study on 326 episodes treated during 1980-2004. Heart 2006;92:1457-62.  Back to cited text no. 8
    
9.
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633-8.  Back to cited text no. 9
    
10.
Lertsapcharoen P, Khongphatthanayothin A, Chotivittayatarakorn P, Thisyakorn C, Pathmanand C, Sueblinvong V. Infective endocarditis in pediatric patients: An eighteen-year experience from King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2005;88 Suppl 4:S12-6.  Back to cited text no. 10
    
11.
Liew WK, Tan TH, Wong KY. Infective endocarditis in childhood: A seven-year experience. Singapore Med J 2004;45:525-9.  Back to cited text no. 11
    
12.
Bitar FF, Jawdi RA, Dbaibo GS, Yunis KA, Gharzeddine W, Obeid M. Paediatric infective endocarditis: 19-year experience at a tertiary care hospital in a developing country. Acta Paediatr 2000;89:427-30.  Back to cited text no. 12
    
13.
Coward K, Tucker N, Darville T. Infective endocarditis in Arkansan children from 1990 through 2002. Pediatr Infect Dis J 2003;22:1048-52.  Back to cited text no. 13
    
14.
Rosenthal LB, Feja KN, Levasseur SM, Alba LR, Gersony W, Saiman L. The changing epidemiology of pediatric endocarditis at a children's hospital over seven decades. Pediatr Cardiol 2010;31:813-20.  Back to cited text no. 14
    
15.
Tissières P, Gervaix A, Beghetti M, Jaeggi ET. Value and limitations of the von Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children. Pediatrics 2003;112:e467.  Back to cited text no. 15
    
16.
Lamas CC, Eykyn SJ. Blood culture negative endocarditis: Analysis of 63 cases presenting over 25 years. Heart 2003;89:258-62.  Back to cited text no. 16
    
17.
Pereira CA, Rocio SC, Ceolin MF, Lima AP, Borlot F, Pereira RS, et al. Clinical and laboratory findings in a series of cases of infective endocarditis. J Pediatr (Rio J) 2003;79:423-8.  Back to cited text no. 17
    
18.
Humpl T, McCrindle BW, Smallhorn JF. The relative roles of transthoracic compared with transesophageal echocardiography in children with suspected infective endocarditis. J Am Coll Cardiol 2003;41:2068-71.  Back to cited text no. 18
    
19.
Niwa K, Nakazawa M, Tateno S, Yoshinaga M, Terai M. Infective endocarditis in congenital heart disease: Japanese national collaboration study. Heart 2005;91:795-800.  Back to cited text no. 19
    
20.
Alshammary A, Hervas-Malo M, Robinson JL. Pediatric infective endocarditis: Has Staphylococcus aureus overtaken viridans group Streptococci as the predominant etiological agent? Can J Infect Dis Med Microbiol 2008;19:63-8.  Back to cited text no. 20
    
21.
Chen CH, Lo MC, Hwang KL, Liu CE, Young TG. Infective endocarditis with neurologic complications: 10-year experience. J Microbiol Immunol Infect 2001;34:119-24.  Back to cited text no. 21
    
22.
McKay G, Bunton R, Galvin I, Shaw D, Singh H. Infective endocarditis - A twelve year surgical outcome series. N Z Med J 2002;115:124-6.  Back to cited text no. 22
    
23.
Campbell M. Incidence of cardiac malformations at birth and later, and neonatal mortality. Br Heart J 1973;35:189-200.  Back to cited text no. 23
    
24.
Khaled AA, Al-Noami AY, Al-Ansi M, Faiza AA. Clinical features and outcome of infective endocarditis in yemeni patients treated with empirical antibiotic therapy. Heart Views 2010;11:2-9.  Back to cited text no. 24
[PUBMED]  Medknow Journal  
25.
Heper G, Yorukoglu Y. Clinical, bacteriologic and echocardiographic evaluation of infective endocarditis in Ankara, Turkey. Angiology 2002;53:191-7.  Back to cited text no. 25
    
26.
Khan NU, Farman MT, Sial JA, Achakzai AS, Saghir T, Ishaq M. Changing trends of infective endocarditis. J Pak Med Assoc 2010;60:24-7.  Back to cited text no. 26
    
27.
Lalani T, Kanafani ZA, Chu VH, Moore L, Corey GR, Pappas P, et al. Prosthetic valve endocarditis due to coagulase-negative staphylococci: Findings from the International Collaboration on Endocarditis Merged Database. Eur J Clin Microbiol Infect Dis 2006;25:365-8.  Back to cited text no. 27
    
28.
Moreillon P, Que YA. Infective endocarditis. Lancet 2004;363:139-49.  Back to cited text no. 28
    
29.
Agarwal R, Bahl VK, Malaviya AN. Changing spectrum of clinical and laboratory profile of infective endocarditis. J Assoc Physicians India 1992;40:721-3.  Back to cited text no. 29
    
30.
Krcmery V, Gogová M, Ondrusová A, Buckova E, Doczeova A, Mrazova M, et al. Etiology and risk factors of 339 cases of infective endocarditis: Report from a 10-year national prospective survey in the Slovak Republic. J Chemother 2003;15:579-83.  Back to cited text no. 30
    
31.
Omezzine-Letaïef A, Alaoui FZ, Bahri F, Mahdhaoui A, Boughzela E, Jemni L. Infectious endocarditis with negative blood cultures. Arch Mal Coeur Vaiss 2004;97:120-4.  Back to cited text no. 31
    
32.
Zamorano J, Sanz J, Almería C, Rodrigo JL, Samedi M, Herrera D, et al. Differences between endocarditis with true negative blood cultures and those with previous antibiotic treatment. J Heart Valve Dis 2003;12:256-60.  Back to cited text no. 32
    
33.
Johnson JA, Boyce TG, Cetta F, Steckelberg JM, Johnson JN. Infective endocarditis in the pediatric patient: A 60-year single-institution review. Mayo Clin Proc 2012;87:629-35.  Back to cited text no. 33