Le Guillou S, Casalta J-P, Fraisse A, Kreitmann B, Chabrol B, Dubus J-C, Bosdure E
Unité de médecine infantile, CHU Timone-Enfants, 264 rue Saint-Pierre, Marseille cedex 5, France.
Arch Pediatr. 2010 Jul;17(7):1047-55. doi: 10.1016/j.arcped.2010.03.019. Epub 2010 May 15.
The aim of our study was to determine the different characteristics of infective endocarditis in children without underlying heart disease. This was a descriptive, retrospective study including all cases of infective endocarditis without underlying heart disease occurring in children under 18 years of age, hospitalized at the Timone Children's Hospital in Marseille, France, between 1997 and 2008. The clinical, microbiological, and echocardiography data; treatment; and outcome were reviewed for each case. Over an 11-year period, 26 children were hospitalized with infective endocarditis. Eleven children (7 boys) had no underlying heart disease (42 %). Their mean age was 8 years and 3 months. Underlying conditions including neoplasm, preterm birth, and central venous catheter were found in 6 cases. A heart murmur was observed in 82 % of the children. A microorganism was isolated in 10 children (91 %). Staphylococcus aureus was the most common agent (45 %), followed by fungi (18 %). Echocardiography detected cardiac complications in 7 cases (64 %). Ninety-one percent of the children received intravenous antibiotics for a mean duration of 45 days. Eighty-two percent of our patients required surgical intervention. In our series, 91 % of the patients met the modified Duke criteria defining infective endocarditis. In-hospital mortality was 11 %. Embolic complications were seen in 5 cases (45 %), patients whose cultures yielded S. aureus or fungal organisms were more likely to present complications. Infective endocarditis without heart disease has particular features that differ from those of congenital heart disease. This diagnosis must be considered when predisposing factors are present.
我们研究的目的是确定无基础心脏病的儿童感染性心内膜炎的不同特征。这是一项描述性回顾性研究，纳入了1997年至2008年期间在法国马赛蒂蒙儿童医院住院的所有18岁以下无基础心脏病的感染性心内膜炎患儿病例。对每个病例的临床、微生物学和超声心动图数据、治疗及结局进行了回顾。在11年期间，26名儿童因感染性心内膜炎住院。11名儿童（7名男孩）无基础心脏病（42%）。他们的平均年龄为8岁3个月。6例患儿存在包括肿瘤、早产和中心静脉导管在内的基础疾病。82%的儿童有心脏杂音。10名儿童（91%）分离出微生物。金黄色葡萄球菌是最常见的病原体（45%），其次是真菌（18%）。超声心动图在7例（64%）中检测到心脏并发症。91%的儿童接受了平均持续45天的静脉抗生素治疗。82%的患者需要手术干预。在我们的系列研究中，91%的患者符合定义感染性心内膜炎的改良杜克标准。住院死亡率为11%。5例（45%）出现栓塞并发症，培养结果为金黄色葡萄球菌或真菌的患者更易出现并发症。无心脏病的感染性心内膜炎具有与先天性心脏病不同的特殊特征。当存在易感因素时，必须考虑这一诊断。
