Infective endocarditis in Arkansan children from 1990 through 2002.
BACKGROUND
Recent medical and surgical advances have increased the potential risk of endocarditis. Epidemiology, pathogens, morbidity and/or mortality may have evolved in the past decade in pediatric patients diagnosed with endocarditis.


METHODS
Retrospective reviews of medical records from Arkansas Children's Hospital were done to identify patients with infective endocarditis from January 1990 through December 2002. Basic demographic and clinical data were gathered and reviewed.


RESULTS
Of 76 patients identified, 57 were included based on diagnostic criteria. Congenital heart disease with (56%) and without (25%) correction were the most common risk factors. Echocardiograms revealed vegetations in 67%. Echocardiograms remain relatively deficient in patients with complex cyanotic heart disease (50% positive) vs. those with normal anatomy (83% positive). Streptococci (30%) and Staphylococcus aureus (21%) were the most common organisms identified overall; however, we observed a predominance of enterococci in infants <2 years of age (41%). Our study revealed a reduced rate of complications, especially of the central nervous system (7% vs. 25 and 33% in prior studies); however, our rate of S. aureus was lower (21% vs. 32 and 39%), and this pathogen continues to be associated with a higher incidence of complications.


CONCLUSIONS
Infective endocarditis continues to present a difficult challenge in pediatrics; its associated pathogens and outcomes have changed little in the past decade.
Coward
Keith
K
Department of Pediatrics, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, USA.
Tucker
Nancy
N
Darville
Toni
T
D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001131:Arkansas / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000379:methods; D003131:Combined Modality Therapy; D015150:Echocardiography, Doppler; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D008297:Male; D008499:Medical Records; D008826:Microbial Sensitivity Tests; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents