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Marín-Cruz I, Pedrero-Tomé R, Toral B, Flores M, Orellana-Miguel MÁ, Boni L, Belda-Hofheinz S, Prieto-Tato LM, Fernández-Cooke E, Epalza C, López-Medrano F, Rojo P, Blázquez-Gamero D. Infective endocarditis in pediatric patients: a decade of insights from a leading Spanish heart surgery reference center. Eur J Pediatr 2024; 183:3905-3913. [PMID: 38913227 PMCID: PMC11322191 DOI: 10.1007/s00431-024-05606-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/04/2024] [Accepted: 05/10/2024] [Indexed: 06/25/2024]
Abstract
Infective endocarditis (IE) is a rare disease in children and is associated with significant morbidity and mortality. In recent years, significant changes have occurred in pediatric care that could have influenced the microbiology and presentation of IE. The aim of this work was to study epidemiological, microbiological, and clinical features of IE treated at a Pediatric Cardiac Surgery Reference Center located in Madrid (Spain) in a 10-years' period. A descriptive observational retrospective study was performed, including pediatric patients < 16 years old with definite or possible IE admitted to a reference center between January 2012 and December 2021. Thirty-two IE episodes were identified. Twenty-eight (87.5%) had congenital heart disease (CHD), 8 (25.0%) were preterm infants, 1 (3.1%) was immunocompromised and 6 (18.8%) had other chronic conditions; in 11 (34.4%) episodes more than one underlying condition was associated. In 20 (62.5%) episodes there was an indwelling central venous catheter (CVC); children with other comorbidities (preterm, immunocompromised, other chronic conditions) were more likely to have a CVC at diagnosis compared with patients with isolated CHD (p < 0.001). Thirty-six microbiological isolates were obtained in the 32 episodes; 4 (12.5%) episodes had 2 isolated microorganisms. Microbiological isolates were 20 (55.6%) Gram-positive bacteria (GPB), 10 (27.8%) non-HACEK Gram-negative bacteria (GNB), 1 (2.8%) HACEK-group bacterium, 4 (11.1%) fungi and 1 (2.8%) Coxiella burnetii. In 10 (31.3%) episodes, patients were colonized by multidrug-resistant bacteria (MDRB) and the etiology of IE in 3 (30.0%) of those episodes was the colonizing MDRB. MDRB colonization was associated with MDRB IE (p = 0.007). The most common complication was septic embolism: 11 (34.4%) episodes (9 pulmonary and 2 cerebral). In-hospital mortality was 6.3% (n = 2), all of them due to underlying conditions and not to IE or its complications. Clinical features and complications of IE episodes caused by non-HACEK GNB and those caused by GPB were compared, finding no statistically significant differences. Conclusion: Risk factors for developing IE, the proportion of embolic complications, and mortality rate were consistent with previously published findings. Proportion of IE cases attributed to non-HACEK GNB was higher than previously reported, suggesting an evolving epidemiology of IE. One-third of children colonized with MDRB subsequently developed IE caused by the same MDRB strains, so empirical coverage of MDRB organisms must be considered when IE is suspected in MDRB colonized patients. No significant differences in clinical features and complications were observed when comparing IE episodes caused by non-HACEK GNB and those caused by GPB, however larger cohort studies are needed. What is Known: • Infective endocarditis (IE) is a rare disease in children, associated with significant morbidity and mortality. • The main risk factor for developing IE in children is an underlying congenital heart disease. What is New: • With current changing epidemiology in pediatric IE, a higher proportion of IE caused by non-HACEK Gram-negative bacteria should be expected. • A significant percentage of children colonized by multidrug-resistant bacteria can develop an IE due to those bacteria.
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Affiliation(s)
- Inés Marín-Cruz
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | - Belén Toral
- Pediatric Cardiology, Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marta Flores
- Pediatric Cardiology, Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Ángeles Orellana-Miguel
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lorenzo Boni
- Cardiothoracic Surgery, Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sylvia Belda-Hofheinz
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
- Mother-Child Health and Development Network (Red SAMID), Carlos-III Health Institute, Madrid, Spain
| | - Luis M Prieto-Tato
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Elisa Fernández-Cooke
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Francisco López-Medrano
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Pablo Rojo
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
- Universidad Complutense de Madrid, Madrid, Spain.
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2
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Essa Y, Said SM. Diagnostic work-up and current management strategies for infective endocarditis in the pediatric population. Indian J Thorac Cardiovasc Surg 2024; 40:29-39. [PMID: 38827553 PMCID: PMC11139826 DOI: 10.1007/s12055-024-01700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 06/04/2024] Open
Abstract
Infective endocarditis (IE) remains a serious disease that is associated with significant morbidity and mortality, and despite the significant advances that have been made in understanding the disease process in past decades, its incidence appears to be on the rise recently. Endocarditis in children is no longer a rare occurrence. This appeared to be related to a combination of the improved survival of children with congenital heart diseases (CHDs), increase use of intracardiac protheses, and catheter-related interventions. The American Heart Association (AHA) 2007 guidelines reduced the recommendations for use of prophylactic antibiotics in those with CHDs which occurred despite the noticeable increase in endocarditis incidence around that time. In general, the recommendations for managing children with IE are derived from the adults' guidelines, and the evidence-base is lacking in many clinical scenarios. Understanding the epidemiology, clinical presentations, microbiology, and outcomes of different management strategies for endocarditis is needed to have a clear and optimal plan for these children. In the current narrative review, we discuss IE in the pediatric population in terms of etiology, predisposing factors, and different treatment strategies for this unique population.
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Affiliation(s)
- Yasin Essa
- Department of Surgery, Division of Pediatric and Adult Congenital Cardiac Surgery, Maria Fareri Children’s Hospital, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595 USA
| | - Sameh M. Said
- Department of Surgery, Division of Pediatric and Adult Congenital Cardiac Surgery, Maria Fareri Children’s Hospital, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595 USA
- Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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3
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Gopal K, Radhakrishnan RM, Jose R, Krishna N, Varma PK. Outcomes after surgery for infective endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:126-137. [PMID: 38827557 PMCID: PMC11139833 DOI: 10.1007/s12055-023-01647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 06/04/2024] Open
Abstract
The role of surgery in infective endocarditis is becoming established the world over. In spite of all recent advances, endocarditis remains a lethal disease following surgery. With the emergence of more difficult-to-treat microorganisms, sicker and older patients with multiple co-morbidities, and an increase in healthcare-associated infections, the need for surgery in the management of infective endocarditis is only bound to increase. Data on the use of surgery in endocarditis till date is largely from observational data due to the relative rarity of the disease and variable practice patterns around the world. Hopefully, with increasing awareness and more inter-institutional and international collaborations, more robust data will emerge to further establish the role of surgery. For the time being, individual patient management will require the active multi-disciplinary approach of an endocarditis team to provide the best possible outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01647-9.
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Affiliation(s)
- Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rohik Micka Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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4
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Awlad Thani S, Al Jamei SM, Al Azri KN, Al Alawi K, Al Shabibi S. Native Aortic Valve Infective Endocarditis Secondary to Community-Acquired Methicillin-Resistant Staphylococcus aureus: A Case Report and Literature Review. Cureus 2024; 16:e55341. [PMID: 38559539 PMCID: PMC10981920 DOI: 10.7759/cureus.55341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Infective endocarditis (IE) refers to a microbial infection affecting either a heart valve or endocardium, resulting in tissue damage and the formation of vegetation. Native aortic valve endocarditis in children is rare and is associated with serious complications related to valvular insufficiency and systemic embolizations. As reports about community-acquired methicillin-resistant Staphylococcus aureus (MRSA) native aortic valve endocarditis in children are very scarce, we report this case along with a literature review about its complications and management. Here, we report the case of a seven-month-old infant who was previously healthy and presented with signs and symptoms of shock and systemic embolizations secondary to native aortic valve IE. His blood culture showed MRSA. He developed aortic valve insufficiency heart failure and multiorgan septic emboli that progressed to fatal refractory multiorgan failure. The management of complicated aortic valve endocarditis in children is challenging and needs a multidisciplinary team approach and prompt intervention.
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5
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Wu DM, Zhu MZL, Buratto E, Brizard CP, Konstantinov IE. Aortic valve surgery in children with infective endocarditis. Semin Thorac Cardiovasc Surg 2023:S1043-0679(23)00038-2. [PMID: 36898419 DOI: 10.1053/j.semtcvs.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/23/2023] [Indexed: 03/12/2023]
Abstract
There is limited data on the outcomes of children who undergo surgery for aortic valve infective endocarditis (IE), and the optimal surgical approach remains controversial. We investigated the long-term outcomes of surgery for aortic valve IE in children, with a particular focus on the Ross procedure. A retrospective review of all children who underwent surgery for aortic valve IE was performed at a single institution. Between 1989 and 2020, 41 children underwent surgery for aortic valve IE, of whom 16 (39.0%) underwent valve repair, 13 (31.7%) underwent the Ross procedure, 9 (21.9%) underwent a homograft root replacement, and 3 (7.3%) underwent a mechanical valve replacement. Median age was 10.1 years (interquartile range [IQR], 5.4-14.1). The majority of children (82.9%, 34/41) had underlying congenital heart disease, while 39.0% (16/41) had previous heart surgery. Operative mortality was 0.0% (0/16) for repair, 15.4% (2/13) for the Ross procedure, 33.3% (3/9) for homograft root replacement, and 33.3% (1/3) for mechanical replacement. Survival at 10 years was 87.5% for repair, 74.1% for Ross, and 66.7% for homograft (p>0.05). Freedom from reoperation at 10 years was 30.8% for repair, 63.0% for Ross, and 26.3% for homograft (p=0.15 for Ross vs. repair, p=0.002 for Ross vs. homograft). Children undergoing surgery for aortic valve IE have acceptable long-term survival, although the need for long-term reintervention is significant. The Ross procedure appears to be the optimal choice when repair is not feasible.
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Affiliation(s)
- Damien M Wu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael Z L Zhu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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6
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Gavcovich T, Al Barbandi M, Millan P, Isner E, Defreitas MJ, Glaberson W, Katsoufis CP, Chandar J, Sigurjonsdottir V, Gonzalez IA, Swaminathan S, Zuo Y, Abitbol CL, Seeherunvong W. Case report: Bordetella holmesii: A rare pathogen causing infective endocarditis associated glomerulonephritis. Front Pediatr 2023; 10:1093300. [PMID: 36727008 PMCID: PMC9884818 DOI: 10.3389/fped.2022.1093300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
Infective endocarditis (IE) can cause multiorgan dysfunction and chronic kidney disease, in addition to cardiac sequelae. The presentation may be vague and can manifest as acute glomerulonephritis. While the most common pathogens of infective endocarditis are Staphylococcus and Streptococcus species, we report a rare pathogen Bordetella holmesii causing infective endocarditis associated glomerulonephritis. A 20-year-old male patient with tetralogy of Fallot with pulmonary atresia and aortopulmonary collaterals underwent several cardiac surgeries including prosthetic pulmonary valve replacement in the past. He was admitted for 3 days at an outside hospital for fever, cough, and hemoptysis, and diagnosed with streptococcal pharyngitis, for which he received antibiotics. Five weeks later, he presented to our institution with lower extremity edema and gross hematuria. On examination, he was afebrile, normotensive, had a 7-kg weight gain with anasarca, and a systolic murmur, without rash. Investigations revealed elevated serum creatinine, nephrotic range proteinuria, hematuria, and hypocomplementemia, consistent with acute glomerulonephritis. Given his cardiac history, blood cultures were collected from three sites. Broad-spectrum antibiotics were initiated when he subsequently developed fever. Renal pathology on biopsy showed diffuse proliferative immune complex-mediated glomerulonephritis. Transesophageal echocardiogram visualized a vegetation on the pulmonary valve. Bordetella holmesii was ultimately cultured from the prior and current hospitalization. A serum sample detecting microbial cell-free DNA sequencing confirmed Bordetella holmesii at very high levels. After completing 6 weeks of intravenous antibiotics with concurrent angiotensin receptor blockade, his kidney function recovered with improvement in hypocomplementemia and proteinuria. This case report highlights the early recognition and comprehensive evaluation of a rare organism causing IE-associated GN, which allowed for renal recovery and preserved cardiac function.
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Affiliation(s)
- Tara Gavcovich
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Malek Al Barbandi
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Pamela Millan
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Elizabeth Isner
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
| | - Marissa J. Defreitas
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Wendy Glaberson
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Chryso P. Katsoufis
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jayanthi Chandar
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Vaka Sigurjonsdottir
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Ivan A. Gonzalez
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Infectious Disease, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Sethuraman Swaminathan
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Cardiology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Yiqin Zuo
- Department of Pathology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Carolyn L. Abitbol
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Wacharee Seeherunvong
- Department of Pediatrics, Holtz Children’s Hospital, Miami, FL, United States
- Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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7
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Swiss Evaluation Registry for Pediatric Infective Endocarditis (SERPIE) - Risk factors for complications in children and adolescents with infective endocarditis. Int J Cardiol 2023; 370:463-471. [PMID: 36334644 DOI: 10.1016/j.ijcard.2022.10.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Infective endocarditis (IE) in pediatric patients is a severe cardiac disease and its actual epidemiology and clinical outcome in Switzerland is scarcely studied. METHODS Retrospective nationwide multicenter data analysis of pediatric IE in children (<18 years) between 2011 and 2020. RESULTS 69 patients were treated for definite (40/69;58%) or possible IE (29/69;42%). 61% (42/69) were male. Diagnosis was made at median 6.4 years (IQR 0.8-12.6) of age with 19 patients (28%) during the first year of life. 84% (58/69) had congenital heart defects. IE was located on pulmonary (25/69;35%), mitral (10/69;14%), tricuspid (8/69;12%) and aortic valve (6/69;9%), and rarely on ventricular septal defect (VSD;4/69;6%) and atrial septal defect (ASD;1/69;1%). In 22% (16/69) localization was unknown. 70% (48/69) had postoperative IE, with prosthetic material involved in 60% (29/48; right ventricular to pulmonary artery conduit (24), VSD (4), ASD (1)). Causative organisms were mostly Staphylococci spp. (25;36%) including Staphylococcus aureus (19;28%), and Streptococci spp. (13;19%). 51% (35/69) suffered from severe complications including congestive heart failure (16;23%), sepsis (17;25%) and embolism (19;28%). Staphylococcus aureus was found as a predictor of severe complications in univariate and multivariate analysis (p = 0.02 and p = 0.033). In 46% (32/69) cardiac surgery was performed. 7% (5/69) died. CONCLUSIONS IE in childhood remains a severe cardiac disease with relevant mortality. The high morbidity and high rate of complications is associated with Staphylococcus aureus infections. Congenital heart defects act as a risk factor for IE, in particular the high number of cases associated with prosthetic pulmonary valve needs further evaluation and therapeutic alternatives.
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8
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Carrillo SA, Duenas H, Blaney C, Eisner M, Nandi D, McConnell PI. Surgical outcomes of infective endocarditis in pediatrics: Moving the needle to a contemporary, multidisciplinary approach. J Thorac Cardiovasc Surg 2023; 165:275-284. [PMID: 35537892 DOI: 10.1016/j.jtcvs.2022.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is an uncommon disease in children that, when present, is accompanied by significant morbidity and mortality. The presence of congenital heart disease often complicates management. The aim of the present study is to describe the characteristics and outcomes of children undergoing surgery for IE. METHODS A retrospective chart review from 2004 to 2020 was conducted to identify consecutive patients younger than age 20 years with IE undergoing surgery. RESULTS A total of 94 patients with IE were identified, of whom 47 underwent surgery at a median age of 16.7 years. Thirty-one patients (65.95%) had congenital heart disease. Vegetation and embolic phenomena occurred in 41 and 29 patients (87.23% and 61.7%), respectively, with the brain as most common location (57.1%). Native valve involvement had a greater tendency to embolize (P < .001). Staphylococcus spp was the most common organism (49%). The mitral valve was the most affected (31.9%). Seven (14.9%) patients had multivalvar involvement and valve replacement was the most common procedure performed (37 patients; 78.7%). There were 3 operative deaths (6.4%). Median length of hospital stay was 21 days. Risk factors for prolonged hospital stay were time to surgery in days (P < .001) and native valvar involvement (P = .05). Five patients (10.6%) had postoperative recurrent IE. Survival at 1 and 5 years was 93.6% and 89.4%, respectively. CONCLUSIONS Children with IE can undergo surgery with acceptable results. The morbidity, but not mortality, is driven by embolic complications. Staphylococcus spp and native valve involvement are significant risk factors. VIDEO ABSTRACT.
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Affiliation(s)
- Sergio A Carrillo
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio.
| | - Helen Duenas
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio
| | - Cristin Blaney
- The Ohio State University, Columbus, Ohio; Division of Cardiology, The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Mariah Eisner
- The Ohio State University, Columbus, Ohio; Biostatistics Resource, Nationwide Children's Hospital, Columbus, Ohio
| | - Deipanjan Nandi
- The Ohio State University, Columbus, Ohio; Division of Cardiology, The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Patrick I McConnell
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio
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9
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Wu DM, Konstantinov IE, Buratto E. Commentary: Multidisciplinary management of pediatric endocarditis: No PIE in the sky. J Thorac Cardiovasc Surg 2023; 165:285-286. [PMID: 35610071 DOI: 10.1016/j.jtcvs.2022.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Damien M Wu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Australia.
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10
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Muacevic A, Adler JR, Kahraman Ö. The Incidence and Clinical Characteristics of Infective Endocarditis in Children: A Five-Year, Single-Centre Retrospective Evaluation. Cureus 2022; 14:e31747. [PMID: 36569694 PMCID: PMC9770546 DOI: 10.7759/cureus.31747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Infective endocarditis (IE) is a rare disease with high mortality and morbidity. In recent years, an increase in the frequency of infective endocarditis has been observed due to the increase in the survival of cases with congenital heart diseases (CHDs) and the use of central catheters. In addition to revealing the incidence of IE in our clinic, this study aimed to evaluate the demographic characteristics, predisposing factors, clinical, laboratory, microbiological, and echocardiographic findings, and the complications of follow-up of our patients diagnosed with IE in light of the literature. MATERIAL AND METHODS Thirteen patients with IE who were hospitalized in Pediatric Cardiology Clinic, Pamukkale University Medical Faculty Hospital between January 2016 and August 2021 were retrospectively reviewed. The patients included in the study were evaluated in terms of demographic characteristics, predisposing factors, clinical, laboratory and microbiological findings, echocardiography data, surgical intervention needs, and complications. The incidence of IE in our clinic was defined as the rate of IE among patients admitted to the hospital and reported as the number of patients with IE per 100,000 hospital admissions. RESULTS The median age of these 13 patients was 11 (7-14) years, and the male/female ratio was 6/7. The five-year IE incidence in Pediatric Cardiology Clinic, Pamukkale University Medical Faculty Hospital, was found to be 2.5 in approximately 100,000 hospital admissions. A predisposing factor was detected in all patients. Six patients (46%) had CHDs, and four patients (31%) had acquired heart disease. The other three (23%) patients were receiving immunosuppressive therapy, and these patients had long-term port catheters. Eight (62%) patients had positive blood cultures. Streptococcus viridans, Streptococcus gordonii, Staphylococcus aureus, coagulase-negativeStaphylococcus, Brucella spp, and Candida albicans were isolated in the blood cultures of these patients. IE-related complications developed in seven (54%) patients. Five (38%) had heart failure, three patients (23%) had thromboembolic events, two (15%) had glomerulonephritis, and one (8%) had thrombophlebitis. Four patients were referred to early surgery. Two patients with recurrent IE attacks were referred to surgery after their treatment was completed. CONCLUSION The incidence of IE has shown an increase recently with increased rates of survival attributable to corrective surgeries performed for congenital heart diseases, increased prosthetic materials used in cardiac surgeries, and increased use of permanent catheters. In our study, the incidence of IE was found to be 2.5 in 100,000 hospital admissions. Our results have shown that rheumatic heart diseases, besides CHDs, are still an important risk factor for Turkey. Due to the low number of cases in IE studies in the pediatric population, there is a need for further studies to be conducted in large series in this field.
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11
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Wu DM, Buratto E, Schulz A, Zhu MZL, Ivanov Y, Ishigami S, Brizard CP, Konstantinov IE. Outcomes of mitral valve repair in children with infective endocarditis: a single-center experience. Semin Thorac Cardiovasc Surg 2022; 35:339-347. [PMID: 35594978 DOI: 10.1053/j.semtcvs.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Mitral valve infective endocarditis (IE) in children is rare, and there are few reports on the outcomes of surgery in these patients. This study investigated the long-term outcomes of mitral valve repair in children with IE. METHODS Data were retrospectively obtained from medical records and correspondence. Univariable regression analyses were performed and outcomes including survival and freedom from reoperation were analysed using the Kaplan-Meier method. RESULTS Surgery for native mitral valve IE was performed in 39 patients between 1987 and 2020. Of these, 92.3% (36/39) of patients underwent mitral valve repair, while 7.7% (3/39) required replacement. Median age was 8 years. Preoperatively, 80.5% (29/36) of patients had moderate or greater mitral regurgitation. Congenital heart disease was present in 38.9% (14/36), while 11.1% (4/36) had rheumatic heart disease and 25.0% (9/36) had prior cardiac surgery. Postoperatively, only 1 patient (2.8%, 1/36) had moderate or greater residual mitral regurgitation. There were 2 early deaths (5.6%, 2/36), with survival being 94.1% (95%CI, 78.5-98.5) at 15-years. At 10-years, freedom from reoperation was 62.9% (95%CI, 41.0-78.5) while freedom from mitral valve replacement was 80.2% (95%CI, 55.5-92.3). Larger vegetation size was a risk factor for embolic events both pre- and postoperatively (OR 1.15, p=0.02). CONCLUSIONS Mitral valve repair is feasible in the majority of children requiring surgery for mitral valve IE. Survival is excellent, and at 10-years, approximately two-thirds of patients are free from mitral reoperation, and 80% are free from replacement. Larger vegetation size is associated with increased risk embolic events.
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Affiliation(s)
- Damien M Wu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne
| | - Antonia Schulz
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne
| | - Michael Z L Zhu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Yaroslav Ivanov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne
| | - Shuta Ishigami
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne.
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Eleyan L, Khan AA, Musollari G, Chandiramani AS, Shaikh S, Salha A, Tarmahomed A, Harky A. Infective endocarditis in paediatric population. Eur J Pediatr 2021; 180:3089-3100. [PMID: 33852085 DOI: 10.1007/s00431-021-04062-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 12/16/2022]
Abstract
Infective endocarditis is very uncommon in children; however, when it does arise, it can lead to severe consequences. The biggest risk factor for paediatric infective endocarditis today is underlying congenital heart defects. The most common causative organisms are Staphylococcus aureus and the viridans group of streptococci. The spectrum of symptoms varies widely in children and this produces difficulty in the diagnosis of infective endocarditis. Infective endocarditis in children is reliant on the modified Duke criteria. The use of blood cultures remains the most effective microbiological test for pathogen identification. However, in blood culture-negative infective endocarditis, serology testing and IgG titres are more effective for diagnosis. Imaging techniques used include echocardiograms, computed tomography and positron emission tomography. Biomarkers utilised in diagnosis are C-reactive protein, with recent literature reviewing the use of interleukin-15 and C-C motif chemokine ligand for reliable risk prediction. The American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines have been compared to describe the differences in the approach to infective endocarditis in children. Medical intervention involves the use of antimicrobial treatment and surgical interventions include the repair and replacement of cardiac valves. Quality of life is highly likely to improve from surgical intervention.Conclusion: Over the past decades, there have been great advancements in clinical practice to improve outcomes in patients with infective endocarditis. Nonetheless, further work is required to better investigative and manage such high risk cohort. What is Known: • The current diagnostic techniques including 'Duke's criteria' for paediatric infective endocarditis diagnosis • The current management guidelines utilised for paediatric infective endocarditis What is New: • The long-term outcomes of patients that underwent medical and surgical intervention • The quality of life of paediatric patients that underwent medical and surgical intervention.
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Affiliation(s)
- Loay Eleyan
- School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Ameer Ahmed Khan
- School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Gledisa Musollari
- Imperial College London, Exhibition Road, South Kensington, London, SW7 2BU, UK
| | | | - Simran Shaikh
- St. Georges University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Ahmad Salha
- St. Georges University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Abdulla Tarmahomed
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, UK
| | - Amer Harky
- Department of Congenital Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK. .,Department of Cardio-thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
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Mahony M, Lean D, Pham L, Horvath R, Suna J, Ward C, Veerappan S, Versluis K, Nourse C. Infective Endocarditis in Children in Queensland, Australia: Epidemiology, Clinical Features and Outcome. Pediatr Infect Dis J 2021; 40:617-622. [PMID: 33902079 DOI: 10.1097/inf.0000000000003110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is a rare entity in children associated with significant morbidity and mortality. To optimize management, it is important to understand local epidemiology, risk factors, clinical features and outcome. These are investigated in this retrospective 10-year study of endocarditis in children in Queensland. METHODS Children <18 years with IE were identified from the state-wide pediatric cardiology center (Mater Children's Hospital, 2009-2014; Queensland Children's Hospital, 2014-2018) through International Classification of Diseases codes and local cardiology database. Clinical records were assessed by a clinician and echocardiograms by a cardiologist. Incidence was calculated using Australian Bureau of Statistics Queensland Estimated Resident Population data, 2019. RESULTS Fifty-one children were identified, with an overall estimated incidence of 0.84 per 100,000 per year; 0.69 per 100,000 in 2009-2013 and 0.99 per 100,000 in 2014-2018, respectively. Twenty-four (47.1%) children were male and 10 (19.6%) were identified as Aboriginal or Torres Strait Islander peoples. Underlying cardiac conditions were present in 29 (56.9%): 25 congenital heart disease, 3 rheumatic heart disease and 1 cardiomyopathy. A causative pathogen was identified in 46 (90.2%) children with Staphylococcus aureus most common. Thirty-six (70.6%) met criteria for "Definite IE" as per modified Duke criteria, with the remainder "Possible IE." Surgery was required in 26 (51%). Median duration of antibiotics was 42 (interquartile range = 32-51) days and hospitalization 49 (interquartile range = 34-75) days. One child died due to IE. CONCLUSIONS IE in children in Queensland is increasing in incidence and is higher than the reported incidence in New Zealand and the United States. Congenital heart disease is the most common risk factor and S. aureus is the commonest responsible organism. Aboriginal or Torres Strait Islander children are over-represented. Mortality remains low.
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Affiliation(s)
- Michelle Mahony
- From the Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
| | - David Lean
- Paediatric Department, Nazarene General Hospital, Papua New Guinea
| | - Lily Pham
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Robert Horvath
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Infective Endocarditis Queensland [ieQ], Brisbane, Australia
- The Prince Charles Hospital, Brisbane, Australia
- Pathology Queensland, Brisbane, Australia
| | - Jessica Suna
- Queensland Paediatric Cardiac Service
- Queensland Paediatric Cardiac Research, Queensland Children's Hospital, Brisbane, Australia
| | - Cameron Ward
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Queensland Paediatric Cardiac Service
- Queensland Paediatric Cardiac Research, Queensland Children's Hospital, Brisbane, Australia
| | | | - Kathryn Versluis
- Queensland Paediatric Cardiac Research, Queensland Children's Hospital, Brisbane, Australia
| | - Clare Nourse
- From the Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Infective Endocarditis Queensland [ieQ], Brisbane, Australia
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Kallikourdis A, Kalavrouziotis G. Infective endocarditis in childhood: moving forward. Eur J Cardiothorac Surg 2021; 60:928-929. [PMID: 34021305 DOI: 10.1093/ejcts/ezab243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonios Kallikourdis
- 1st Department of Cardio-Thoracic Surgery, "Aghia Sophia" Children's Hospital of Athens, Athens, Greece
| | - Georgios Kalavrouziotis
- 1st Department of Cardio-Thoracic Surgery, "Aghia Sophia" Children's Hospital of Athens, Athens, Greece
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Lee JH, Kwak JG, Cho S, Kim WH, Lee JR, Kwon HW, Song MK, Lee SY, Kim GB, Bae EJ. Surgical outcomes of infective endocarditis in children: should we delay surgery for infective endocarditis? Eur J Cardiothorac Surg 2021; 60:920-927. [PMID: 33842975 DOI: 10.1093/ejcts/ezab149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We compared the surgical outcomes of infective endocarditis (IE) between early surgery and non-early surgery groups in children. METHODS From January 2000 to April 2020, we retrospectively reviewed 50 patients <18years of age who underwent first surgery for IE. Early surgery was defined as that performed within 2 days for left-sided IE and 7 days for right-sided IE after diagnosis. RESULTS The median age and body weight at operation were 7.7 years [interquartile range (IQR), 2.3-13.2] and 23.7 kg (IQR, 10.3-40.7), respectively. The median follow-up duration was 9.5 years (IQR, 4.0-14.5). In 28 patients with native valve endocarditis, the native valve was preserved in 23 (82.1%). The most common causative microorganism was Streptococcus viridans (32.0%). The operative mortality was 2.0%, and 13 (26.0%) patients required reoperation most commonly for prosthesis failure (n = 7). There were no significant differences in patient characteristics and perioperative data between early surgery (n = 9) and non-early surgery (n = 36) groups, except for the interval between diagnosis and surgery (early surgery < non-early surgery, P < 0.001) and preoperative negative blood culture conversion (early surgery < non-early surgery, P = 0.025). There were no significant differences in overall survival, recurrent IE, and reoperation rate between the groups. Early surgery and preoperative negative blood culture conversion were not found as significant factors for surgical adverse outcomes. CONCLUSIONS Surgical outcomes for IE in children were acceptable irrespective of the time of surgery. Our results suggest that it may not be required to delay surgery for IE and the potential benefit of early surgery could be expected in children.
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Affiliation(s)
- Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jeong Ryul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Hye Won Kwon
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Sang-Yun Lee
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
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Yakut K, Ecevit Z, Tokel NK, Varan B, Ozkan M. Infective Endocarditis in Childhood: a Single-Center Experience of 18 Years. Braz J Cardiovasc Surg 2021; 36:172-182. [PMID: 33113327 PMCID: PMC8163273 DOI: 10.21470/1678-9741-2020-0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.
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Affiliation(s)
- Kahraman Yakut
- Department of Pediatric Cardiology, Baskent University School of Medicine, Ankara, Turkey
| | - Zafer Ecevit
- Department of Pediatric Infectious Diseases, Baskent University School of Medicine, Ankara, Turkey
| | - Niyazi Kursad Tokel
- Department of Pediatric Cardiology, Baskent University School of Medicine, Ankara, Turkey
| | - Birgul Varan
- Department of Pediatric Cardiology, Baskent University School of Medicine, Ankara, Turkey
| | - Murat Ozkan
- Department of Cardiovascular Surgery, Baskent University School of Medicine, Ankara, Turkey
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Buratto E, Konstantinov IE. Aortic valve surgery in children. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)32235-2. [PMID: 32891449 DOI: 10.1016/j.jtcvs.2020.06.145] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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Commentary: Surgical outcome for infective endocarditis in children during long term follow-up. J Thorac Cardiovasc Surg 2019; 158:1411-1412. [PMID: 31623808 DOI: 10.1016/j.jtcvs.2019.07.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 11/22/2022]
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Commentary: Purulence in the heart of a child? This should not be. J Thorac Cardiovasc Surg 2019; 158:1410. [PMID: 31371108 DOI: 10.1016/j.jtcvs.2019.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/20/2022]
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