Frequency of Infective Endocarditis Among Infants and Children With Staphylococcus aureus Bacteremia

Abstract

ABSTRACT. Purpose. The prevalence of infective endocarditis (IE) among children with Staphylococcus aureus bacteremia (SAB) is unknown. The objective of this study was to determine prospectively the prevalence of IE among pediatric patients with SAB in a large tertiary care center.Methods. Between July 1998 and June 2001, all children who developed SAB whose parent/guardian signed informed consent underwent echocardiography. Clinical and follow-up results were collected prospectively. Endocarditis was classified according to the modified Duke criteria.Results. Fifty-one children developed SAB during the study interval. Definite (6 patients [11.8%]) or possible (4 patients [7.8%]) IE was present in 10 of 51 (20%) children with SAB. Most children (73%) developed bacteremia as a consequence of an infected intravascular device. Children with underlying congenital heart disease had a significantly higher prevalence of definite or possible IE, compared with those with structurally normal hearts (53% vs 3%). All patients with definite IE had multiple positive blood cultures. Mortality was high among patients with and without IE (40% vs 12%).Conclusions. In this study, the prevalence of definite IE among children with SAB was ϳ12% and was frequently associated with congenital heart disease and multiple positive blood cultures. The mortality for children with SAB and definite or possible S aureus IE is high. Pediatrics 2005;115:e15-e19. URL: www.pediatrics.org/cgi/

Bacterial Pancarditis with Myocardial Abscess: Successful Surgical Intervention in a 14-Month-Old Boy

“…[2][3][4] In children with Staphylococcus bacteremia, there is a 12% incidence of infective endocarditis, 4,5 and 90% of the reported cases have occurred in children with congenital heart disease. 4 The mortality rate in S. aureus pericarditis is as high as 40%, chiefly because of cardiac tamponade.…”

“…[2][3][4] In children with Staphylococcus bacteremia, there is a 12% incidence of infective endocarditis, 4,5 and 90% of the reported cases have occurred in children with congenital heart disease. 4 The mortality rate in S. aureus pericarditis is as high as 40%, chiefly because of cardiac tamponade. 1 Our case exemplifies the difficulty in the diagnosis and treatment of such patients: our patient, who had a structurally normal heart, presented with signs of cardiac tamponade caused by purulent pericarditis, and during his hospital stay he developed mitral and tricus- pid valve endocarditis and a ventricular septal abscess despite appropriate antibiotic therapy.…”

Community-Associated Meticillin Resistant Staphylococcus aureus: increased burden of infections in children and young people in Queensland and Australia

“…In this study, multivariate analysis showed that pulmonary infection (for <1yr and 11-20yr age groups), infective endocarditis (age 0-10yrs), underlying chronic medical conditions (in those aged >1yr) and hospital-acquired infections (age 11-20yrs) were associated with increased mortality. In other studies, infective endocarditis (227), no identified source for infection and younger age (228) were factors associated with an increased risk of death from SAB.…”

“…Reported use of echocardiography varied widely. In six series, echocardiography appeared to be used fairly extensively (215,217,222,223,227,232) . For example, in the study from Cambridge, UK (215), 80% of children with SAB had echocardiography following implementation of Infectious Diseases consultation for SAB (there was one case in the total 63 patients of IE).…”

“…Mortality was associated with co-morbidities (213,223,224,227,234), and was higher in some developing country studies (228). One study (221) found 4% mortality for SAB from meticillin-susceptible S. aureus (MSSA) strains and 10% if caused by MRSA, but the difference was not statistically significant.…”