title: Changing spectrum of infective endocarditis in children: a 30 years experiences from a tertiary care center in Taiwan.
abstract: BACKGROUND
  The epidemiology of infective endocarditis (IE) changes with the medical advances. This study aimed to evaluate the trends in a pediatric cohort.
  
  
  METHODS
  From hospital database (1983-2011), patients <18 years who fulfilled the modified Duke criteria of IE were identified.
  
  
  RESULTS
  We enrolled 112 patients (M/F 57/55) with 116 IE episodes. About 86 patients (74.1%) had preexisting cardiac lesions and 23 patients (19.6%) were immunocompromised hosts. Prior dental procedure was noted in 12 (10.3%) patients, including 4 with simple ventricular septal defect. The overall mortality was 10.7%. The risk factors included vegetations in both ventricles (odds ratio = 7.81, P = .019) and prior use of broad-spectrum antibiotics (odds ratio = 3.75, P = .055). Approximately one-third of the patients (29.3%) required surgical intervention. We identified an increasing trend in the proportion of hospital-acquired IE (from 12% during 1983-1991 to 39% during 2002-2011), and the spectrum of offending pathogens showed a trend for fewer Streptococcus species, more Staphylococcus aureus and increased pathogen diversity. The leading pathogens were Gram-negative bacilli in hospital-acquired IE and Streptococcus species in community-acquired IE. Hospital-acquired IE was associated with younger age, a higher proportion of immunocompromised patients, a history of central line indwelling and higher mortality. In contrast, more surgical intervention and embolic events occurred in community-acquired IE patients.
  
  
  CONCLUSIONS
  The mortality of pediatric IE remains high. Dental procedures were noted in one-tenth of the patients. Although increased S. aureus-caused episodes and pathogen diversity were noted, Streptococcus species remain the most common pathogen.
authors.affiliation: From the *Department of Emergency; and †Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wei-Chieh
authors.initials: WC
authors.lastname: Tseng
authors.forename: Shuenn-Nan
authors.initials: SN
authors.lastname: Chiu
authors.forename: Pei-Lan
authors.initials: PL
authors.lastname: Shao
authors.forename: Jou-Kou
authors.initials: JK
authors.lastname: Wang
authors.forename: Chun-An
authors.initials: CA
authors.lastname: Chen
authors.forename: Ming-Tai
authors.initials: MT
authors.lastname: Lin
authors.forename: Chun-Wei
authors.initials: CW
authors.lastname: Lu
authors.forename: Mei-Hwan
authors.initials: MH
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003729:Dental Care / Q000009:adverse effects; D004696:Endocarditis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000401:mortality; D009057:Stomatognathic Diseases / Q000150:complications; D013290:Streptococcal Infections / Q000453:epidemiology / Q000401:mortality; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D062606:Tertiary Care Centers