Infective endocarditis in the pediatric patient: a 60-year single-institution review

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.

FIGURE 1

Echocardiograms from a 10-year-old patient with infective endocarditis occurring after cardiac surgery (Konno operation for aortic root enlargement and aortic valve replacement). Note the prominent vegetation (arrow) in the left ventricular outflow tract attached to the aortic valve homograft. A, Parasternal long-axis view. B, Parasternal short-axis view.

FIGURE 2

Single-slice computed tomographic image from a 5-month-old patient with complex congenital heart disease and enterococcal endocarditis. Note the 2 large mycotic aneurysms (*) emerging from the descending aorta and proximal left iliac artery.