Infective endocarditis in children with congenital heart disease: cumulative incidence and predictors.
BACKGROUND
The American Heart Association guidelines for prevention of infective endocarditis (IE) in 2007 reduced the groups of congenital heart disease (CHD) patients for whom antibiotic prophylaxis was indicated. The evidence base in CHD patients is limited. We sought to determine the risk of IE in children with CHD.


RESULTS
We performed a population-based analysis to determine the cumulative incidence and predictors of IE in children (0-18 years) with CHD by the use of the Quebec CHD Database from 1988 to 2010. In 47 518 children with CHD followed for 458 109 patient-years, 185 cases of IE were observed. Cumulative incidence of IE was estimated in the subset of 34 279 children with CHD followed since birth, in whom the risk of IE up to 18 years of age was 6.1/1000 children (95% confidence interval, 5.0-7.5). In a nested case-control analysis, the following CHD lesions were at highest risk of IE in comparison with atrial septal defects (adjusted rate ratio, 95% confidence interval): cyanotic CHD (6.44, 3.95-10.50), endocardial cushion defects (5.47, 2.89-10.36), and left-sided lesions (1.88, 1.01-3.49). Cardiac surgery within 6 months (5.34, 2.49-11.43) and an age of <3 years (3.53, 2.51-4.96; reference, ages 6-18) also conferred an elevated risk of IE.


CONCLUSIONS
In a large population-based cohort of children with CHD, we documented the cumulative incidence of IE and associated factors. These findings help identify groups of patients who are at the highest risk of developing IE.
Department of Epidemiology, Biostatistics and Occupational Health; McGill University, Montreal, Canada (D.R., J.S.K., R.I.-I., L.P., A.J.M.); Division of Cardiology, Stollery Children's Hospital, Edmonton, Canada (A.S.M.); Division of General Internal Medicine, McGill University Health Center, Montreal, Canada (L.P.); and McGill Adult Unit for Congenital Heart Disease, McGill University Health Center, Montreal, Canada (J.T., A.J.M.).
Dinela
D
Rushani
Jay S
JS
Kaufman
Raluca
R
Ionescu-Ittu
Andrew S
AS
Mackie
Louise
L
Pilote
Judith
J
Therrien
Ariane J
AJ
Marelli
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004696:Endocarditis / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D011159:Population Surveillance / Q000379:methods; D011237:Predictive Value of Tests
congenital; endocarditis; epidemiology; heart defects, congenital