Infective endocarditis in infants and children during the past ten years

Infective endocarditis occurs infrequently in the general pediatric population, but is often associated in patients with underlying heart disease. Even today it remains a serious threat leading to relevant mortality in all pediatric groups, in spite of better antibiotic treatment and prophylactic measures for endangered persons. This retrospective analysis reports experience here with infective endocarditis in children.The clinical and laboratory findings in 28 children with 30 episodes of infective endocarditis, from July 1984 to June 1993, were reviewed retrospectively.Twenty-one children (75 percent) had congenital heart disease, three (11 percent) had rheumatic heart disease and four (14 percent) had no underlying cardiac abnormality prior to presentation. Twenty-six (87 percent) of the 30 episodes had positive blood cultures. The most common organism isolated was streptococcus viridans (14 percent), followed by staphylococcus aureus (7 percent). Echocardiography identified vegetation in 21 of 28 (75 percent) patients. Twenty children were successfully treated medically. Four developed complications requiring surgery, of whom two died. A total of six children (21 percent) died of the disease or its complications. There were a high case fatality rate for children below the age of two years (75 percent), and children without an underlying cardiac abnormality (50 percent).It was concluded that patient survival is dependent on several factors which include early diagnosis, appropriate antimicrobial therapy and aggressive surgical intervention.