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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

The 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.

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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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

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:

© 2014 by Lippincott Williams & Wilkins, Inc.