Infective endocarditis in children: A 10-year multicentric study

Abstract

Congenital heart disease (CHD) represents a predisposing condition for the development of infective endocarditis (IE). In recent years, the reduction in the incidence of rheumatic heart disease, advances in cardiac surgery and the increased use of long-term central venous catheters (CVC) in subjects without CHD have changed significantly the epidemiology of the disease. We sought to evaluate the epidemiology of IE in children in the north of France. We retrospectively included all children < 18 years hospitalised for IE in 2008-2018 in 4 tertiary centres. Demographic, underlying conditions, echocardiography, microbiology and outcomes were collected. We identified 64 episodes of IE in 60 children. Incidence was 3,07/10 000 paediatric hospitalisations. Median age was 8 years [0–13] and distribution was bimodal with peaks in infancy and adolescence. An organism pathogen was isolated in 87% of cases. The most common was Staphylococcus aureus (34%) then streptococcus (25%). At echocardiography, anomalies were vegetations ( n = 32), new valvular regurgitations ( n = 10), peri valvular abscesses ( n = 2). Among cohort, 45 had a CHD (70%), 7 were pre-term birth (11%), 2 had long-term CVCs and 10 no predisposition. Non-CHD patients were significantly younger than CHD patients ( Table 1 ). Anomalies at echocardiography and identification of pathogen were more common in non-CHD patients. Among CHD patients, 38 (84%) had previous heart surgery and 10 presented an IE < 2 months after surgery. Pulmonary bioprosthetic valve were involved in 22 cases and mechanical valve in three. Cardiac surgery was needed in 26 cases (41%) including valve replacement in half of them. Complications of IE occurred in 35 (58%) including emboli, mycotic aneurysm, cerebral haemorrhage and myocardial abscess. IE mostly occurred in predisposed children. IE in CHD and non-CHD patients has different features, diagnosis is more arduous and needs more investigation as nuclear medicine imaging.