Infective endocarditis in children: a single cohort study of 51 cases in a French university hospital
Abstract number: P1827
Abouchraa A., Zahar J.R., Carbonnelle E., Bajolle F., Ribadeau-Dumas F., Mechai F., Offredo C., Sidi D., Lortholary O.
Introduction: Infective endocarditis (IE) in children is rare. Considering the lack of recent data, we performed an epidemiological study to determine diagnostic, therapeutic and outcome features of infective endocarditis in the paediatric setting.
Materials and Methods: We conduct a retrospective study of children IE cases at Necker Enfants-Malades university hospital in Paris (19942006). All had a definite IE according to Duke criteria. Data collected included, demographics, underlying heart disease, type of valvular damage, septic localisations, microbiological data, antibiotic therapy and outcome.
Results: From 51 children recorded, 37 (72.5%) were boys, with a median age of 10 years [3 months-17 y ]. Median time from symptom's onset to treatment was 7 days. The average follow-up period was 49 months. Thirty nine patients (76%) had congenital heart disease or a valve damaged. Mitral and tricuspid valves were involved in 27% of cases. In 14 cases (27.4%) a foreign cardiac material was infected Thirty two cases (62.7%) had a valvular failure, 3 children had a annular abscess. Ten (19.6%) cases were nosocomially acquired (2 staphylococci, 1 Gram-negative bacillus, 1 enterococcus, 3 yeasts). Portal of entry was identified in 27 cases. Gram-positive cocci accounted for 70.6% (36 cases) (streptococci 17 cases, staphylococci 17 cases and enterococci 2 cases). Twenty patients (39.2%) experienced arterial embolism with lung (10 cases), and brain (6 cases), being the most frequent organs involved. Twelve patients (23.4%) had a severe clinical form (ie, septic shock, acute renal failure, myocardial dysfunction) The treatment was medical alone in 26 cases and medico-surgical in 25 cases.
To date 46 patients (90%) are alive and 5 (9.8%) died, the death occurred in 2 cases during treatment at 8 and 23 days after diagnosis because of ventricular tachychardia. Recurrent endocarditis was detected in 4 children (a new episode of valvular infection occurred in 2 cases and a relapse in 2 cases). One patient surgically treated and 4 treated medically, died
Conclusion: In our children endocarditis study, 20% are nosocomially acquired with foreign cardiac materials in 28%. The most frequent portal of entry was dental, 87% of children had a 4 years survival free of any cardiac event.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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