Children's Research Center, Zurich, Switzerland.
Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
Infection. 2020 Oct;48(5):671-678. doi: 10.1007/s15010-020-01433-4. Epub 2020 Apr 30.
In 2007, antibiotic prophylaxis (AP) guidelines for infective endocarditis (IE) changed, but the possible influence on the annual incidences of pediatric IE is unclear.
We studied the clinical and epidemiologic impact of AP change by comparing two time periods before and after change of AP guidelines in a tertiary care center as referral center for a total population of more than 4,500,000 inhabitants.
After change of AP guidelines, twenty-five patients were diagnosed for IE at a median age of 6.9 years (range 0.1-19.4, female 48%). Modified Duke criteria were fulfilled for definite (12/25; 48%), or probable IE (13/25; 52%). The frequency of IE (cases per 1000 hospitalized patients) increased from 0.37% (1995-2005) to 0.59% (2006-2017) [p = 0.152], the annual incidence of IE (cases per 1000 CHD patients, < 20 years of age) increased from 0.195 ‰ to 0.399 ‰ [p = 0.072]. Postoperative IE (13/25; 52%), was associated mostly with prosthetic pulmonary valves (12/13; 92%). Pathogens were staphylococci spp. (8/25; 32%), streptococci spp. (7/25; 28%), HACEK (3/25; 12%), other (4/25; 16%), or culture-negative (3/25; 12%). Treatment included antibiotics (25/25; 100%), and cardiac surgery (16/25; 64%). The clinical findings and complications of pediatric IE including mortality (2/25; 8%) did not differ between the two time periods.
Pediatric IE remains a severe cardiac disease with a comparable clinical picture. Unless increasing absolute case numbers of IE, the relative case number of IE remains stable despite AP change. The high number of prosthetic pulmonary valve associated IE needs further evaluation and therapeutic alternatives.
2007 年，感染性心内膜炎（IE）的抗生素预防（AP）指南发生了变化，但这对儿科 IE 的年发病率的可能影响尚不清楚。
我们通过比较 AP 指南改变前后两个时间段，在一家三级医疗中心（服务人群超过 450 万）研究 AP 改变的临床和流行病学影响，该中心是儿科 IE 的转诊中心。
AP 指南改变后，25 例患者被诊断为 IE，中位年龄 6.9 岁（范围 0.1-19.4，女性 48%）。采用改良的 Duke 标准，确诊 IE（25 例中有 12 例；48%）或可能 IE（25 例中有 13 例；52%）。IE（每 1000 例住院患者中的病例数）的发生率从 0.37%（1995-2005 年）增加到 0.59%（2006-2017 年）[p=0.152]，每 1000 例先心病患者（<20 岁）IE 的年发病率从 0.195‰增加到 0.399‰[p=0.072]。术后 IE（25 例中有 13 例；52%）主要与人工肺动脉瓣有关（13 例中有 12 例；92%）。病原体为葡萄球菌属（25 例中有 8 例；32%）、链球菌属（25 例中有 7 例；28%）、HACEK 群（25 例中有 3 例；12%）、其他（25 例中有 4 例；16%）或培养阴性（25 例中有 3 例；12%）。治疗包括抗生素（25 例中有 25 例；100%）和心脏手术（25 例中有 16 例；64%）。两个时间段儿科 IE 的临床发现和并发症（包括死亡率，25 例中有 2 例；8%）没有差异。
儿科 IE 仍然是一种严重的心脏病，具有相似的临床表现。除非 IE 的绝对病例数增加，否则 AP 改变后 IE 的相对病例数保持稳定。与人工肺动脉瓣相关的大量 IE 需要进一步评估和治疗选择。
