[New trends in pediatric endocarditis].
OBJECTIVE
To evaluate the epidemiology, etiology and outcome of endocarditis in a cohort of pediatric patients and to compare the main characteristics with our previous experience.


METHODS
Patients aged less than 18 years of age diagnosed with endocarditis at the Sainte-Justine Hospital, University of Montreal between 1-1986 and 12-2000 were studied. The recent case series was compared with our previous experience from 1960-1985.


RESULTS
Fifty-six children with endocarditis were included in the 1986-2000 series: 35 children with congenital heart disease, 15 with serious underlying disease and six healthy children. The mean age was 7 years and 10 months. Fifty-four percent of the patients were boys. The incidence of endocarditis increased from 1.5 cases/year in the 1986-2000 series to 4 cases/year in the 1986-2000 series. In the 1986-2000 series, 10 (17.9 %) patients had a central catheter. Sixteen (28.6 %) patients had a vascular prosthesis. Blood cultures were positive in 50 patients (89 %): Streptococci were found in 48 % of the patients and Staphylococci in 34 %. Echocardiography was positive in 36 of 55 patients (65.4 %). All children were treated with intravenous antibiotics for a mean of 43 +/- 15 days. There were no recurrences. Significant morbidity developed in 26 patients (46 %). Embolic phenomena were seen in 11 children (20 %). Twelve patients (21 %) needed surgery. Of the six healthy children, five developed complications. Overall, seven children (12.5 %) died; all were older than 6 years of age. Comparing our experience from 1960-1985 with that from 1986-2000 revealed that morbidity decreased from 85.7 % to 46.4 % and mortality decreased from 27 % to 12.5 %.


CONCLUSIONS
Physicians must recognize that children with underlying immunodeficiency and those with central catheters have an increased risk of endocarditis. Healthy children with endocarditis have a greater risk of complications. Morbidity and mortality due to endocarditis has diminished considerably in recent years.
Carceller
A
A
Servicio de Pediatría, Departamento de Pediatría, CHU Sainte-Justine, Université de Montréal, Québec, Canadá. ana_carceller@ssss.gouv.qc.ca
Lebel
M H
MH
Larose
G
G
Boutin
C
C
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003710:Demography; D004562:Electrocardiography; D004696:Endocarditis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010372:Pediatrics / Q000379:methods* / Q000639:trends*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents