[Trends in pediatric infective endocarditis in a tertiary pediatric center in Israel].
BACKGROUND
The characteristics of pediatric infective endocarditis (IE) are continuously changing.


OBJECTIVE
To describe trends in pediatric IE over a period of 25 years.


METHODS
Children (< 18 years old] treated at Schneider Children's Medical Center during 1992-2004 who met Duke criteria for definite or possible IE were included in the study. Demographic, clinical and laboratory data were collected and compared to data gathered during 1980-1991.


RESULTS
Compared to 1980-1991, during 1992-2004 we noted a decrease in the mean age from 6.5 to 4 years and in the incidence of congenital heart defects from 96% to 61% (p = 0.001). Incidence of significant underlying diseases and non-cardiac predisposing factors rose from 4% to 43%. Significantly Less children presented with fever, splenomegaly and murmur during 1992-2004; a 4-fold increase in surgical intervention [p = 0.024) and a 3-fold increase in mortality p = 0.257 were observed. Viridans streptococci (37.5%), Staphylococcus aureus (20.8%) and gram-negative bacilli 2.5%] caused most of IE during 1980-1992, whereas viridians streptococci (19.1%), Candida spp (17%), S. aureus (17%) and coagulase-negative staphylococci (12.8%) were the common causes during 1992-2004.


CONCLUSIONS
Considerable changes in pediatric IE were observed.


CONCLUSIONS
Pediatric IE became an infection of young children, especially those with significant noncardiac underlying diseases. It is less commonly caused by viridans streptococci and is increasingly caused by Candida spp and coagulase-negative staphylococci. These trends may affect the management of pediatric IE.
Department of Pediatrics A, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. dmarom@clalit.org.il
Daphna
D
Marom
Einat
E
Birk
Shai
S
Ashkenazi
D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004696:Endocarditis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D006330:Heart Defects, Congenital / Q000150:complications* / Q000453:epidemiology; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data