Clinical and Echocardiographic Characteristics of Pediatric Infective Endocarditis and Predictors of Embolic Events: Experience from A Tertiary Center

Abstract

Background Pediatric infective endocarditis (IE) is uncommon but associated with considerable morbidity and mortality. This study aimed to identify the clinical and echocardiographic characteristics of IE in children and predictors of embolic events during hospitalization. Methods We identified children diagnosed with IE between January 2010 and December 2021 in our hospital. Demographic data, symptoms, underlying microorganisms, echocardiographic characteristics, underlying heart disease (HD), and outcome were documented. Results Ninety children were enrolled, and 60% had underlying HD. The most common causative microbial species was Staphylococcus aureus, which was more likely in non-HD patients than in HD patients (p = 0.030). Echocardiography detected vegetations in 88 cases, involving the left heart in 41 patients, the right heart in 45 patients, and both sides in two patients. Vegetations were more often detected in the right heart in HD patients and more common in the left heart in non-HD patients (p < 0.001). Embolic events (EEs) occurred in 25 patients, more often seen in non-HD patients (44.4% vs. 16.7%, p = 0.004). Vegetations disappeared in nine patients, while four died during hospitalization. Logistic regression analysis showed that the absence of HD and the presence of moderate or severe valvular dysfunction independently predicted EEs. Conclusions IE more often involved the left heart in non-HD patients and the right heart in HD patients. We should pay more attention to non-HD patients and those with valvular dysfunction, as they have a higher risk of EEs.