[Clinical study and analysis of risk factors for mortality in 86 cases of infectious endocarditis in children and adolescents in Argentina: 1988-2000].
BACKGROUND
IE is a rare infection in children. Scarce reports with large number of patients are published.


METHODS
Between January 1988 to December 2000 we analyzed all cases of IE cases admitted to our hospital.


RESULTS
86 cases of IE (4.9/10,000 admissions) in 86 children were diagnosed. The median age was 7.6 years. In 77% of patient previous cardiac disease was detected, interventricular defects and Tetralogy of Fallot were the more frequent. Three percent of children had rheumatic heart disease. Thirty-six percent of children had previous heart surgery. Fifty-seven percent have been received previous antibiotics. Eighty-seven percent had positive blood cultures, being the S. aureus and S. viridans the predominantly. Forty-eight percent of children had complications. The metabolic disorders and the nosocomial infections were the most frequent. Twenty-four percent required surgery, 24% of them in the first week of the diagnosis. The mortality in operated children was 19%. In the multivariate analysis we could observe that children with more than 7 years and S. aureus isolation in blood cultures had more incidence of complications and posterior surgery (p < 0.05). Children with S. aureus IE had longer duration of fever, more incidence of complications than patients with S. viridans IE (p < 0.05). Ten percent of children were treated as outpatients. The global mortality was 12,8%. Previous surgery (OR = 6.89; IC 95% 1.54-30.7) and previous antibiotic treatment (OR = 9.98; IC 95% 1.12-88.8) were the factors related with higher mortality in the multivariate analysis. S. aureus was the predominat pathogen and caused more morbidity and mortality than S. viridans IE.


CONCLUSIONS
Children with IE with previous surgery and previous antibiotic treatment died with more frequency.
Servicio de Control Epidemiológico e Infectología, Hospital de Pediatría Profesor Dr. Juan P. Garrahan, Buenos Aires, Argentina. hpaganini@intramed.net.ar
Hugo
H
Paganini
Verónica
V
Firpo
Alejandra
A
Villa
Roberto
R
Debbag
Griselda
G
Berberian
Lidia
L
Casimir
Rosa
R
Bologna
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004198:Disease Susceptibility; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D006330:Heart Defects, Congenital / Q000150:complications / Q000453:epidemiology; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality; D012214:Rheumatic Heart Disease / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000472:pathogenicity; D013290:Streptococcal Infections / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D015163:Superinfection; D014463:Ultrasonography; D034363:Viridans Streptococci / Q000302:isolation & purification / Q000472:pathogenicity; D014774:Virulence
D000900:Anti-Bacterial Agents