Eleven year review of infective endocarditis

Abstract

Twenty children were treated for infective endocarditis (IE) at Our Lady's Hospital for Sick Children during an eleven year period from January 1980 to December 1990. One child had I.E. on two occasions due to different microorganisms. Two had Down syndrome. Congenital heart disease (CHD) was the single most common underlying condition and there was none with rheumatic heart disease. Two had no clinically recognised cardiac anomaly. 13/20 (65%) had acyanotic heart disease and 5/20 (25%) had cyanotic CHD. Among the acyanotic group, ventricular septal defect was most common (6/13); followed by aortic lesions (4/13). There was one case each of coarctation of aorta, patent ductus arteriosus and interrupted aortic arch. Transposition of the great arteries was most common among the cyanotic group (3/5). Four children in the cyanotic group had systemic to pulmonary artery shunts; Blalock Taussig (2), Waterston (1), and aortopulmonary (1). Infection was caused by Streptococcus viridans in 10/20 (50%) and Staphylococcus aureus in 7/20 (35%). Kingella Kingae, Neisseria meningitidis and Streptococcus faecalis were the pathogens in the remainder (15%). Vegetations were detected by echocardiography in 12/19 (63%). The mean duration of antibiotic treatment was 5 weeks (1 day-18 weeks). Surgical intervention was necessary in 4 children (20%). Fifteen children (75%) survived and the mean follow up period was 22.6 months (15 days-6 1/2 years). The overall mortality was 25%.