Tseng Wei-Chieh, Chiu Shuenn-Nan, Shao Pei-Lan, Wang Jou-Kou, Chen Chun-An, Lin Ming-Tai, Lu Chun-Wei, Wu Mei-Hwan
From the *Department of Emergency; and †Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Pediatr Infect Dis J. 2014 May;33(5):467-71. doi: 10.1097/INF.0000000000000145.
The epidemiology of infective endocarditis (IE) changes with the medical advances. This study aimed to evaluate the trends in a pediatric cohort.
From hospital database (1983-2011), patients <18 years who fulfilled the modified Duke criteria of IE were identified.
We enrolled 112 patients (M/F 57/55) with 116 IE episodes. About 86 patients (74.1%) had preexisting cardiac lesions and 23 patients (19.6%) were immunocompromised hosts. Prior dental procedure was noted in 12 (10.3%) patients, including 4 with simple ventricular septal defect. The overall mortality was 10.7%. The risk factors included vegetations in both ventricles (odds ratio = 7.81, P = .019) and prior use of broad-spectrum antibiotics (odds ratio = 3.75, P = .055). Approximately one-third of the patients (29.3%) required surgical intervention. We identified an increasing trend in the proportion of hospital-acquired IE (from 12% during 1983-1991 to 39% during 2002-2011), and the spectrum of offending pathogens showed a trend for fewer Streptococcus species, more Staphylococcus aureus and increased pathogen diversity. The leading pathogens were Gram-negative bacilli in hospital-acquired IE and Streptococcus species in community-acquired IE. Hospital-acquired IE was associated with younger age, a higher proportion of immunocompromised patients, a history of central line indwelling and higher mortality. In contrast, more surgical intervention and embolic events occurred in community-acquired IE patients.
The mortality of pediatric IE remains high. Dental procedures were noted in one-tenth of the patients. Although increased S. aureus-caused episodes and pathogen diversity were noted, Streptococcus species remain the most common pathogen.
随着医学进步，感染性心内膜炎（IE）的流行病学发生了变化。本研究旨在评估儿科队列中的趋势。
从医院数据库（1983 - 2011年）中，识别出符合IE改良杜克标准的18岁以下患者。
我们纳入了112例患者（男/女57/55），共发生116次IE发作。约86例患者（74.1%）有既往心脏病变，23例患者（19.6%）为免疫功能低下宿主。12例（10.3%）患者有既往牙科手术史，其中4例为单纯室间隔缺损。总体死亡率为10.7%。危险因素包括双心室赘生物（比值比 = 7.81，P = 0.019）和既往使用广谱抗生素（比值比 = 3.75，P = 0.055）。约三分之一的患者（29.3%）需要手术干预。我们发现医院获得性IE的比例呈上升趋势（从1983 - 1991年期间的12%升至2002 - 2011年期间的39%），致病病原体谱显示链球菌种类减少、金黄色葡萄球菌增多且病原体多样性增加的趋势。医院获得性IE的主要病原体是革兰阴性杆菌，社区获得性IE的主要病原体是链球菌种类。医院获得性IE与年龄较小、免疫功能低下患者比例较高、中心静脉置管史及较高死亡率相关。相比之下，社区获得性IE患者发生更多手术干预和栓塞事件。
儿科IE的死亡率仍然很高。十分之一的患者有牙科手术史。虽然金黄色葡萄球菌引起的发作和病原体多样性增加，但链球菌种类仍然是最常见的病原体。
