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Changing Spectrum of Infective Endocarditis in Children: A 30 Years Experiences from a Tertiary Care Center in Taiwan

Tseng, Wei-Chieh MD*; Chiu, Shuenn-Nan MD, PhD; Shao, Pei-Lan MD; Wang, Jou-Kou MD, PhD; Chen, Chun-An MD, PhD; Lin, Ming-Tai MD, PhD; Lu, Chun-Wei MD; Wu, Mei-Hwan MD, PhD

Pediatric Infectious Disease Journal: May 2014 - Volume 33 - Issue 5 - p 467–471
doi: 10.1097/INF.0000000000000145
Original Studies

Background: The epidemiology of infective endocarditis (IE) changes with the medical advances. This study aimed to evaluate the trends in a pediatric cohort.

Methods: From hospital database (1983–2011), patients <18 years who fulfilled the modified Duke criteria of IE were identified.

Results: We enrolled 112 patients (M/F 57/55) with 116 IE episodes. About 86 patients (74.1%) had preexisting cardiac lesions and 23 patients (19.6%) were immunocompromised hosts. Prior dental procedure was noted in 12 (10.3%) patients, including 4 with simple ventricular septal defect. The overall mortality was 10.7%. The risk factors included vegetations in both ventricles (odds ratio = 7.81, P = .019) and prior use of broad-spectrum antibiotics (odds ratio = 3.75, P = .055). Approximately one-third of the patients (29.3%) required surgical intervention. We identified an increasing trend in the proportion of hospital-acquired IE (from 12% during 1983–1991 to 39% during 2002–2011), and the spectrum of offending pathogens showed a trend for fewer Streptococcus species, more Staphylococcus aureus and increased pathogen diversity. The leading pathogens were Gram-negative bacilli in hospital-acquired IE and Streptococcus species in community-acquired IE. Hospital-acquired IE was associated with younger age, a higher proportion of immunocompromised patients, a history of central line indwelling and higher mortality. In contrast, more surgical intervention and embolic events occurred in community-acquired IE patients.

Conclusions: The mortality of pediatric IE remains high. Dental procedures were noted in one-tenth of the patients. Although increased S. aureus-caused episodes and pathogen diversity were noted, Streptococcus species remain the most common pathogen.

From the *Department of Emergency; and Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.

Accepted for publication October 17, 2013.

The authors have no funding or conflicts of interest to disclose.

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Address for correspondence: Mei-Hwan Wu, MD, PhD, Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-San South Road, Taipei 100, Taiwan. E-mail: wumh@ntu.edu.tw.

© 2014 by Lippincott Williams & Wilkins, Inc.