Are the Duke Criteria Superior to the Beth Israel Criteria for the Diagnosis of Infective Endocarditis in Children?

Stockheim, Janet A.; Chadwick, Ellen G.; Kessler, Susan; Amer, Michael; Abdel‐Haq, Nahed; Dajani, Adnan S.; Shulman, Stanford T.

doi:10.1086/515021

Cited by 106 publications

(51 citation statements)

References 13 publications

(3 reference statements)

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“…The similar frequency in male and female patients in our analyses stands in contrast to the male predominance in infections in general and IE specifically. [12][13][14] We found that S aureus was the most common causative organism and that prosthetic valve IE was caused by organisms similar to those affecting patients without prosthetic valves; these data are consistent with other recent reports on IE. 1,2,14 The mortality rate in the KID, 5.3%, was lower than that reported in the adult population (18% to 23%) 15,16 or in recent pediatric IE series from large clinical centers caring for children with the most complex forms of CHD (10% to 11%).…”

Section: Discussionsupporting

confidence: 91%

Characteristics of Children Hospitalized With Infective Endocarditis

et al. 2009

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Background-Infective endocarditis in children is rare, and most reports describe the experience in referral centers. The purpose of our study was to assess the characteristics of children with infective endocarditis in a large national sample. Methods and Results-We analyzed hospital discharge records with International Classification of Diseases, ninth revision, codes indicating infective endocarditis among admissions of patients Ͻ21 years of age in the Kids' Inpatient Databases 2000 and 2003; analyses for the 2 years were combined. In 1588 hospitalizations, the age distribution was bimodal, with peaks in infancy and late adolescence. The organism was coded in 632 admissions; Staphylococcus aureus was most common (57%), followed by the viridans group of streptococci (20%). Preexisting heart disease was present in 662 patients admitted (42%), among whom 81% had congenital heart disease, 8% had prosthetic valve endocarditis, and 5% had rheumatic heart disease. In-hospital mortality occurred in 84 patients (5%), 38 with preexisting heart disease. Mortality was 48% in the 25 patients with tetralogy of Fallot and pulmonary atresia, and 8% in the 54 patients with prosthetic valve endocarditis. Among 46 deaths without preexisting heart disease, S aureus was the causative organism in 13 of 14 patients (93%) beyond infancy; among 32 infants who died, 31% were premature. Conclusions-In 2000 and 2003, we found a continuing shift in the epidemiology of pediatric infective endocarditis toward a higher proportion of children without preexisting heart disease. Risk factors for mortality included some forms of congenital heart disease and, among patients without preexisting heart disease, premature/neonatal age and S aureus as an etiologic agent.

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Section: Discussionsupporting

confidence: 91%

Characteristics of Children Hospitalized With Infective Endocarditis

et al. 2009

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“…Ferrieri et al conducted a review of the literature and found that VGS was the most common cause of IE in children. The studies reviewed found VGS to be the cause of between 32 and 43% of cases (15,30,36,51). In addition, 27 to 33% of IE was caused by S. aureus, which was the second most common etiologic agent.…”

Section: Clinical Significancementioning

confidence: 99%

It's Not Easy Being Green: the Viridans Group Streptococci, with a Focus on Pediatric Clinical Manifestations

2010

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2The viridans group streptococci (VGS) are a heterogeneous group of organisms that can be human commensals, colonizing the gastrointestinal and genitourinary tracts in addition to the oral mucosa. VGS are generally considered to be of low pathogenic potential in immunocompetent individuals. However, in certain patient populations, VGS can cause invasive disease, such as endocarditis, intra-abdominal infection, and shock. Within the VGS, the rates and patterns of antimicrobial resistance vary greatly depending upon the species identification and the patient population. In general, Streptococcus mitis group organisms are resistant to more antimicrobial agents than the other VGS species. This review addresses current VGS taxonomy, in addition to the current methodologies being used in clinical microbiology laboratories for identification of VGS. Automated systems struggle overall with species level identification and susceptibility testing for VGS. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) identification is emerging as a potential alternative for organism identification. A review of recent pediatric-specific data regarding the clinical manifestations of VGS revealed that the Streptococcus anginosus group (SAG) organisms may be important pathogens in pediatric patients and that the VGS may contribute to disease in patients with cystic fibrosis. It also appears that rates of antimicrobial resistance in VGS in pediatric patients are surpassing those of the adult population. TAXONOMY AND MICROBIOLOGYThe viridans group streptococci (VGS) are a heterogeneous group of organisms that can be both commensal flora and pathogens in humans. They are the "grab bag" that remains when the beta-hemolytic streptococci, enterococci, and pneumococci are excluded from the streptococci. The purpose of this review is to summarize the currently accepted taxonomic classification of this group of organisms, examine the state of the art for identification of the VGS, and then focus on the pediatric clinical manifestations associated with the VGS.Perhaps the only consistency observed in discussions regarding the taxonomy of the VGS is a lack of consistency. The taxonomy is very controversial, and for many years, a standardized naming scheme or typing system for this group of organisms was lacking; therefore, discussions on this topic frequently include the phrase "poorly classified." There are now at least 30 recognized species of VGS (11,14).

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“…Clinically definite IE by the Duke criteria requires the presence of 2 major criteria, 1 major criterion and 3 minor criteria, or 5 minor criteria (Table 1). Direct comparison of the Duke and Beth Israel criteria has been made in 11 major studies 5,[7][8][9][10][11][12][13][14][15][16] including nearly 1700 patients comprising geographically and clinically diverse groups (adult, pediatric, elderly [aged Ͼ60 years], patients from the community, those with and without IVDA, and patients with both native and prosthetic valves). These studies 5,[7][8][9][10][11][12][13][14][15][16] have confirmed the improved sensitivity of the Duke criteria and the diagnostic utility of echocardiography in identifying clinically definite cases (Table 3).…”

Section: Diagnosis Clinical Criteriamentioning

confidence: 99%