Department of Pediatrics A, Schneider Children's Medical Center, Petach Tikva, Israel.
Pediatr Infect Dis J. 2011 Jul;30(7):585-8. doi: 10.1097/INF.0b013e31820f66c7.
Infective endocarditis (IE) in children is continuously changing in regard to underlying conditions, predisposing factors, etiologic agents, clinical manifestations, treatment, and outcome. We describe current characteristics and compare healthcare-associated and community-associated disease.
All children (<18 years) who were treated at our center between January 1992 through June 2004 and met the Duke criteria for definite or possible IE were included. Demographic, clinical, and laboratory data were collected. Cases were categorized as healthcare- or community-associated.
A total of 50 children with IE were identified (51 events; 0.32/1000 hospitalizations). Twenty children (41%) had an isolated congenital heart disease, 13 (25%) had an underlying chronic disease, 9 (18%) were previously healthy, and 8 (16%) were preterm. Mortality rate was 12% (6/51). Compared with the community-associated cases (21/51, 41%), the healthcare-associated cases (30/51, 59%) showed female preponderance, younger age, 1.7-fold longer hospitalization, 1.6-fold longer time to pathogen eradication, and 3.4-fold higher mortality. The leading causes of healthcare-associated IE were Candida sp (8/30, 27%), coagulase-negative staphylococci (6/30, 20%), and Gram-negative bacilli (5/30, 16%). By contrast, the leading causes of community-associated IE were viridans streptococci (8/21, 38%) and Staphylococcus aureus (4/21, 19%).
A high proportion of pediatric IE is healthcare-associated that occurs in younger and sicker children. Healthcare-associated IE differs from community-associated IE in the patients' age, causative pathogens, and mortality. These trends and the different etiologies may affect future antibiotic management of this important pediatric infection.
儿童感染性心内膜炎（IE）在基础条件、易患因素、病原体、临床表现、治疗和预后方面不断变化。我们描述了当前的特点，并比较了与医疗保健相关和社区相关的疾病。
所有在 1992 年 1 月至 2004 年 6 月期间在我们中心接受治疗并符合 Duke 标准的明确或可能 IE 的儿童(<18 岁)均被纳入研究。收集了人口统计学、临床和实验室数据。病例分为与医疗保健相关和社区相关。
共确定了 50 例 IE 患儿（51 例）（0.32/1000 例住院）。20 例（41%）患儿患有孤立性先天性心脏病，13 例（25%）患儿患有潜在慢性疾病，9 例（18%）患儿之前健康，8 例（16%）患儿为早产儿。死亡率为 12%（6/51）。与社区相关病例（21/51，41%）相比，医疗保健相关病例（30/51，59%）表现为女性为主、年龄较小、住院时间长 1.7 倍、病原体清除时间长 1.6 倍、死亡率高 3.4 倍。医疗保健相关 IE 的主要病原体是念珠菌属（8/30，27%）、凝固酶阴性葡萄球菌（6/30，20%）和革兰氏阴性杆菌（5/30，16%）。相比之下，社区相关 IE 的主要病原体是草绿色链球菌（8/21，38%）和金黄色葡萄球菌（4/21，19%）。
儿童 IE 中有相当比例是与医疗保健相关的，发生在年龄较小和病情较重的儿童中。与社区相关的 IE 在患者年龄、病原体和死亡率方面与社区相关的 IE 不同。这些趋势和不同的病因可能会影响这种重要儿科感染未来的抗生素管理。
