engleski

Paediatric infective endocarditis: case series

Background: Congenital heart disease (CHD) is the predominant underlying condition for infective endocarditis (IE) in children. Increasingly, IE develops in the absence of CHD, mostly in patients with central venous catheters. In 8 to 10% of all cases there is no identifiable risk factor. Materials/methods: A total of 11 cases of IE in patients younger than 18 years of age were treated in University Hospital for Infectious Diseases in Zagreb in the past 14 years (2005- 2018). Clinical manifestations, causative pathogens and treatment outcome were retrospectively analysed using medical records. Results: There were 7 boys and 4 girls, aged 7 months to 17 years (median 7 years). 55% of cases were caused by usually isolated bacteria (2 Coagulase-negative Staphylococcus, 2 Staphylococcus aureus, 1 Streptococcus sanguinis, 1 Streptococcus gordonii), while almost half of them (45%) were caused by relatively uncommon organisms in pediatric population: Enterococcus faecalis (n=2), Granulicatella adiacens (n=1), Haemophilus parainfluenzae (n=1) and Abiotrophia defectiva (n=1). Although one patient (9%) didn´t have risk factor for IE, all of the others had CHD and one of them had central venous catheter as well. Septic embolisation was present in 2 patients: meningoencephalitis in a patient with S. aureus IE and pulmonary involvement in a case with S. gordonii IE. Two patients had relapse of IE (caused by CoNS and Staphylococcus aureus). The most frequent antibiotic regimen for first 2 weeks of therapy was penicillin or its derivatives combined with gentamicin. Total duration of treatment was 6-8 weeks. Mortality rate was 18%, while others recovered completely. Conclusions: IE is a rare bacterial infection usually affecting children with CHD. Although IE is uncommon in children without risk factors, it should be suspected in patients with nonspecific clinical symptoms. In our case series Staphylococcus spp predominated as causative microorganism. We also noticed high proportion of cases caused by unusual bacteria and relatively low prevalence of streptococcal IE.

Congenital heart disease ; infective endocarditis ; children

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