Difficulties in Diagnosis and Therapy of Infective Endocarditis in Children and Adolescents—Cohort Study

Abstract

Despite the progress in management and prophylaxis measures, infective endocarditis (IE) is still a condition associated with high mortality rates and severe complications. Fortunately, the incidence of IE is much lower in children and adolescents, with only 0.05–0.12/1000 cases being reported in hospitalized pediatric patients. According to recent data, IE is, in most cases, a complication of pre-existing congenital heart disorders, in up to 75–90% of cases. About 8–10% of all IE cases occur in children without a pre-existing heart condition, due to the widespread use of catheters and invasive procedures, or are associated with immunosuppression. The overall mortality rate due to IE among children and adolescents is 16–25%, a fairly high incidence despite advances made in management and treatment methodologies. We present a retrospective case study conducted in the Pediatric Cardiology Department of ‘St. Maria’ Emergency Children’s Hospital of Iași between February 2007 and February 2020, including 54 children aged between 23 days and 17 years. Our study was aimed at revealing the evolution of IE in recent years in the pediatric population, at identifying the main causes leading to the onset and progress of the disease, at assessing the incidence of clinical and paraclinical manifestations and at determining efficient diagnosis and therapy approaches for the population under survey.

The Incidence and Clinical Characteristics of Infective Endocarditis in Children: A Five-Year, Single-Centre Retrospective Evaluation

“…Fungal endocarditis is a rare disease that occurs in patients with predisposing factors. It mainly occurs in immunocompromised patients who have received broad-spectrum antibiotic therapy and have heart valve replacement and/or pacemakers [19][20][21]. In our study, fungal IE was detected in a patient with a catheter followed up for rhabdomyosarcoma and receiving active chemotherapy.…”

“…Although blood cultures have a very important place in both the diagnosis and treatment of IE, 5-68% of patients had negative blood cultures. It has been reported that the reasons for this are the use of antibiotics before culture taking, infections caused by slow-growing microorganisms, or the use of inadequate microbiological techniques [ 7 , 20 - 23 ]. In our study, 38% of patients had negative blood cultures.…”

“…Staphylococcal species and streptococcal species in children are the most common bacteria causing endocarditis [ 1 - 5 , 6 , 20 ]. In our study, 75% of the microorganisms, were isolated in the blood culture had been Staphylococcus species and Streptococcus species.…”

Pediatric Infective Endocarditis: A Literature Review

“…About 50–70% of pediatric IE is seen in patients with congenital heart disease [ 7 , 8 , 9 ], which is the main predisposing condition. Conversely, in adult patients, the most common heart diseases predisposing to IE include degenerative valve disease or valve replacement surgery with prosthesis implantation, which are significantly more common than in children [ 10 ].…”

“…Some examples are those with immunodeficiency, patients with frequent invasive interventions or with central catheters (chemotherapy, nutrition, or haemodialysis), and institutionalized patients [ 8 ]. Children with cancer present several concurrent risk factors, such as tumor-related immunosuppression, nutritional deficit, chemotherapy, and the placement of catheters and central vascular accesses [ 7 , 18 , 19 ]. The frequency of IE in this group has increased substantially in recent years and the rise in cases will probably continue in the next coming years as the survival of pediatric cancer keeps improving.…”