title: Pneumococcal endocarditis in children: a nationwide survey in Japan.
abstract: 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.
authors: Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan. ishiwada@faculty.chiba-u.jp
authors: Naruhiko
authors: N
authors: Ishiwada
authors: Koichiro
authors: K
authors: Niwa
authors: Shigeru
authors: S
authors: Tateno
authors: Masao
authors: M
authors: Yoshinaga
authors: Masaru
authors: M
authors: Terai
authors: Makoto
authors: M
authors: Nakazawa
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents