Webb Rachel, Voss Lesley, Roberts Sally, Hornung Tim, Rumball Elizabeth, Lennon Diana
From the *Department of Pediatric Infectious Diseases, Starship Children's Hospital, Auckland; †Department of Microbiology, Auckland District Health Board; ‡Department of Pediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland; and §School of Population Child and Youth Health, University of Auckland, Auckland, New Zealand.
Pediatr Infect Dis J. 2014 May;33(5):437-42. doi: 10.1097/INF.0000000000000133.
New Zealand is a developed country with high incidence of bacterial infections and postinfectious sequelae including rheumatic heart disease. We sought to describe the clinical and microbiology features of children with infective endocarditis (IE) between 1994 and 2012.
Retrospective review of patients <16 years identified from hospital records.
In total 85 episodes occurred in 82 children and 68 (80%) were classified as Definite IE and 17 as Possible IE according to modified Duke criteria. From Pacific Island countries, 13 cases were referred. There were 72 children who originated in New Zealand, of whom 52% were either indigenous New Zealand Maori or Pacific migrants. The median age at diagnosis was 7 (0-15) years. Of the 85 cases, 51 (60%) had congenital heart disease 10 children with rheumatic heart disease developed IE. Of the 85 cases, 35 (41%) met our criteria for healthcare-associated IE. 39/85 underwent surgery for IE. As direct result of IE, 4 (4.7%) children died and 9% of survivors had neurologic sequelae. Attributable in-hospital mortality was 4.7%. Staphylococcus aureus was the most common organism, accounting for 26 episodes (30.6%). Other notable pathogens included Corynebacterium diphtheriae (10 cases, 11.8%) and Streptococcus pyogenes (7 cases, 8.2%). In 6 episodes, the microbiologic diagnosis was made by 16S ribosomal RNA testing of excised cardiac tissue.
Congenital heart disease was the major risk factor for IE; however, rheumatic heart disease is also an important risk factor in New Zealand, with implications for local endocarditis prophylaxis recommendations. In addition to a high burden of healthcare-associated and staphylococcal IE, pathogens such as C. diphtheriae and S. pyogenes occurred. 16S ribosomal RNA testing is a useful tool to determine the etiologic agent in culture-negative IE.
新西兰是一个发达国家，细菌感染及包括风湿性心脏病在内的感染后后遗症发病率很高。我们试图描述1994年至2012年间感染性心内膜炎（IE）患儿的临床和微生物学特征。
对从医院记录中识别出的16岁以下患者进行回顾性研究。
82名儿童共发生85次发病，根据改良的杜克标准，68例（80%）被归类为确诊IE，17例为可能IE。有13例患者来自太平洋岛国。72名儿童来自新西兰，其中52%是新西兰原住民毛利人或太平洋移民。诊断时的中位年龄为7（0 - 15）岁。85例病例中，51例（60%）患有先天性心脏病，10例风湿性心脏病患儿发生了IE。85例病例中，35例（41%）符合我们关于医疗保健相关IE的标准。85例中有39例因IE接受了手术。作为IE的直接后果，4名（4.7%）儿童死亡，9%的幸存者有神经系统后遗症。可归因的住院死亡率为4.7%。金黄色葡萄球菌是最常见的病原体，占26次发病（30.6%）。其他值得注意的病原体包括白喉棒状杆菌（10例，11.8%）和化脓性链球菌（7例，8.2%）。在6次发病中，通过对切除的心脏组织进行16S核糖体RNA检测做出了微生物学诊断。
先天性心脏病是IE的主要危险因素；然而，风湿性心脏病在新西兰也是一个重要的危险因素，这对当地的心内膜炎预防建议有影响。除了医疗保健相关和葡萄球菌性IE负担较重外，还出现了白喉棒状杆菌和化脓性链球菌等病原体。16S核糖体RNA检测是确定培养阴性IE病原体的有用工具。
