Pneumococcal endocarditis in children: a nationwide survey in Japan.
BACKGROUND
Infective endocarditis (IE) due to Streptococcus pneumoniae (S. pneumoniae) carries a high mortality rate. However, little is known about pneumococcal IE in children and no optimal therapy has been established. Thus, we attempted to identify the clinical features of this disorder through a Japanese nationwide survey.


METHODS
Members of the Japanese Society of Pediatrics Cardiology and Cardiac Surgery registered 170 pediatric patients with IE diagnosed during a 5-year period (1997-2001). Nine of these patients (5.3%) had pneumococcal IE. The clinical course, treatment and outcome of these 9 patients, aged 7 months to 4 years, were analyzed.


RESULTS
Pneumococcal IE was associated with congenital heart disease in 7 patients and accompanied by other systemic infections including meningitis, pneumonia and otitis media, in 4 patients. Five of the 9 (55.6%) strains isolated by blood culture were penicillin-resistant S. pneumoniae strains. Seven patients were treated with carbapenem. Three underwent cardiac surgery due to cardiac failure and/or vegetation. One died due to septic shock on the first day of hospitalization.


CONCLUSIONS
In children, pneumococcal endocarditis is often accompanied by severe systemic infections. The majority of pediatric cases are caused by penicillin-resistant S. pneumoniae strains. Carbapenem is an effective for IE caused by penicillin-resistant S. pneumoniae. This survey might be helpful to establish proper management strategies for pediatric pneumococcal IE.
Ishiwada
Naruhiko
N
Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan. ishiwada@faculty.chiba-u.jp
Niwa
Koichiro
K
Tateno
Shigeru
S
Yoshinaga
Masao
M
Terai
Masaru
M
Nakazawa
Makoto
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate
D000900:Anti-Bacterial Agents