Day Michael D, Gauvreau Kimberlee, Shulman Stanford, Newburger Jane W
Department of Cardiology, Children's Hospital Boston and the Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
Circulation. 2009 Feb 17;119(6):865-70. doi: 10.1161/CIRCULATIONAHA.108.798751. Epub 2009 Feb 2.
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.
We analyzed hospital discharge records with International Classification of Diseases, ninth revision, codes indicating infective endocarditis among admissions of patients <21 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. Death occurred in 12 of 25 patients (48%) with tetralogy of Fallot and pulmonary atresia, and 4 of 54 (8%) 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, 10 (31%) were premature.
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.
儿童感染性心内膜炎较为罕见，大多数报告描述的是转诊中心的经验。我们研究的目的是评估一个大型全国性样本中儿童感染性心内膜炎的特征。
我们分析了2000年和2003年儿童住院数据库中年龄小于21岁患者入院记录的国际疾病分类第九版编码，这些编码表明患有感染性心内膜炎；对这两年的分析进行了合并。在1588次住院治疗中，年龄分布呈双峰型，在婴儿期和青春期后期出现高峰。在632次入院治疗中记录了病原体；金黄色葡萄球菌最为常见（57%），其次是草绿色链球菌（20%）。662名入院患者（42%）存在基础心脏病，其中81%患有先天性心脏病，8%患有人工瓣膜心内膜炎，5%患有风湿性心脏病。84名患者（5%）在住院期间死亡，其中38名患有基础心脏病。患有法洛四联症和肺动脉闭锁的25名患者中有12名（48%）死亡，人工瓣膜心内膜炎的54名患者中有4名（8%）死亡。在46名无基础心脏病的死亡患者中，14名婴儿期以后的患者中有13名（93%）的病原体为金黄色葡萄球菌；在32名死亡婴儿中，10名（31%）为早产儿。
在2000年和2003年，我们发现儿童感染性心内膜炎的流行病学持续向无基础心脏病儿童比例更高的方向转变。死亡风险因素包括某些形式的先天性心脏病，以及在无基础心脏病的患者中，早产/新生儿期和金黄色葡萄球菌作为病原体。
