Objetive: to describe and analyze clinical and epidemiological aspects of IE en pediatric patients.
Methods: Retrospective study in a level three pediatric hospital. Clinical charts of patients < 18 years with diagnosis of IE at Hospital de Niños “R. Gutierrez” from 03/2010- 03/2018 were reviewed. IE diagnosis was based on modified Duke criteria.
Results: The study included 49 IE, with definite Duke criteria in 71% and possible in 29%. Annual rate: 6.4/10000 admissions (95% CI 4.7-8.5).
Of 49, 38 (78%) had congenital heart disease (CHD) and 11 (22%) were in healthy patients (HP) without structural heart disease. Median age: 7 years old (r: 7 days-17 y). 15 (31%) were younger than 1 year. Male: 45%.
Among 38 CHD, 25 (51%) had previous cardiac surgery. Septal defects (29%) and tetralogy of Fallot (16%) were the most frequent defects.
Fever (91%) was the prevalent clinical sign.
Blood cultures were positive in 45 (92%), S. aureus 18 (40%) and S. viridans 11(22%) were the most frequent pathogens. Comparing the IE caused by S. aureus vs viridans group streptococci IE, S aureus was isolated in younger patients: 7.4 vs 137.3 months (p= 0.03); had more days of bacteremia: 7.41 vs 2.9 (p<0.001), had more association with sepsis: 72% vs 8% (p= 0.002) and it was more frequent in HP than in CHD: 82% vs 50% (p< 0.001).
Patients with previous cardiac surgery were younger (Median age: 7.7 mo-p=0.01) than the rest. Gram-negative bacilli and S aureus were the predominant pathogens in them.
A decrease in age at diagnosis of IE in patients with CHD was observed, <2015: 9.7 y old vs > 2015: 0.6 y old (p = 0.03).
Complications were detected in 29 (58%) of cases. The most frequent were embolic events (32%) and heart failure (22%); 20 (41%) required surgical treatment; 4 patients (8%) died.
Conclusion: S. aureus EI was predominant in healthy patients, occurred at a younger age and was associated with sepsis and more days of bacteremia. S viridans prevailed in CHD.
A significant decrease in age at IE diagnosis in CHD patients was observed. In the last years, IE was more frequent in < 1 year old, related to neonatal surgeries increase.
M. E. Pannunzio,
C. Carballo, None
M. Lopez Daneri, None
C. Hyon Hu, None
W. Conejeros Parodi, None
A. Fallo, None
E. Lopez, None