Infective endocarditis in pediatric patients: an eighteen-year experience from King Chulalongkorn Memorial Hospital.
OBJECTIVE
To review the clinical features and outcome of the pediatric patients diagnosed with infective endocarditis (IE) at King Chulalongkorn Memorial Hospital over an 18-year period.


METHODS
From January 1987 to December 2004, 57 pediatric patients; 28 females and 29 males, age ranged from 2 months to 15 years, mean of 8.64 +/- 3.82 years, classified as "definite" IE according to the Duke criteria were reviewed.


RESULTS
Of the 57 patients, 42 patients (74%) had underlying congenital heart diseases, 7 patients (12%) had underlying rheumatic heart disease, 8 patients (14%) had previously normal heart. Nine patients had history of previously palliative or corrective surgery. Blood cultures were positive in 26 patients (46%). Streptococci and staphylococci were the most commonly isolated organisms. Two-dimensional echocardiography demonstrated vegetations in 56 patients (98%). The location of the vegetations was in the right heart in 30 patients (54%) and in the left heart in 26 patients (46%). Complications occurred in 28 patients (49%). Common complications included congestive heart failure, cerebral emboli, septic shock, and mycotic aneurysm. The overall mortality was 11% (6 patients). By statistical analysis, vegetations in the left heart had a higher incidence of complication than that in the right heart. The vegetation size of > or =10 mm had a significant higher incidence of embolic events.


CONCLUSIONS
The clinical features and outcomes of the present study have a similar pattern as the earlier studies. The rates of complications and mortality are still high.
Lertsapcharoen
Pornthep
P
Department of Pediatrics, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Khongphatthanayothin
Apichai
A
Chotivittayatarakorn
Pairoj
P
Thisyakorn
Chule
C
Pathmanand
Chotima
C
Sueblinvong
Viroj
V
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006333:Heart Failure / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification; D013785:Thailand; D013997:Time Factors