Características clínicas y evolutivas de niños con endocarditis infecciosa hospitalizados en dos centros asistenciales de referencia: Uruguay 2000 - 2010

María Soledad Iglesias; Sebastián González Dambrauskas; Javier Guidice; Gustavo Giachetto; María Catalina Pirez

Authors

María Soledad Iglesias Ministerio de Salud Pública, Centro Hospitalario Pereira Rossell, Hospital Pediátrico. Ex Residente de Pediatría
Sebastián González Dambrauskas Ministerio de Salud Pública, Centro Hospitalario Pereira Rossell, Hospital Pediátrico. Ex Residente de Pediatría. Residente de Terapia Intensiva Pediátrica
Javier Guidice Administración de los Servicios de Salud del Estado, Centro Hospitalario Pereira Rossell, Policlínica de Cardiología Infantil,. Pediatra, cardiólogo
Gustavo Giachetto Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Hospital Pediátrico, Clínica Pediátrica,. Prof. Titular
María Catalina Pirez Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Hospital Pediátrico, Clínica Pediátrica,. Prof. Titula r

Keywords:

BACTERIAL ENDOCARDITIS, CLINICAL EVOLUTION

Abstract

Introduction: infective endocarditis (IE) is rather unusual in children, being morbimortality rates high. Variations determining modifications in the therapeutic approach have been described in terms of their epidemiology and etiology.
Objective: to describe the clinical characteristics and evolution of children with IE in two reference centers in Uruguay: Pereira Rossell Hospital Center (CHPR) and Child Cardiology Institute (ICI), from 2000 through 2010.
Method: observational, descriptive, retrospective study. Risk factors were analysed along with clinical characteristics, etiology, echocardiographic and necropsy findings, and complications in children between 0 and 14 years old with IE. Duke criteria were used to define cases.
Results: 25 children were identified, 15 boys, average age was 48.2 months. Sixteen children evidence structural heart disease: congenital heart disease (15), and rheumatic heart disease (1). Ten of the children with congenital heart disease had undergone cardiac surgery or invasive vascular procedures. Bacterial etiology was confirmed in 23 cases, being Staphylococcus aureus isolated in 9. Twenty children evidenced valve vegetations and 17 children underwent surgery. Five of them suffered embolic complications. Five children died. Necropsy was performed in one patient.
Conclusion: timely blood cultures enabled the identification of the etiological agent in most cases. Staphylococcus was the most frequent etiology and thus, empirical antibiotic therapy needs to consider this finding. The high rate of IE in children without heart disease is pointed out. In this series, serious complications were observed, requiring surgery. Mortality was 20%.

References

(1) Day MD, Gauvreau K, Shulman S, Newburger JW. Characteristics of children hospitalized with infective endocarditis. Circulation 2009; 119(6):865-70.
(2) Canceller A. Endocarditis infecciosa. An Pediatr (Barc) 2005; 63 (5): 383-9.
(3) Rosenthal LB, Feja KN, Levasseur SM, Alba LR, Gersony W, Saiman L. The changing epidemiology of pediatric endocarditis at a children’s hospital over seven decades. Pediatr Cardiol 2010; 31(6):813-20.
(4) Liew WK, Tan TH, Wong KY. Infective endocarditis in childhood: a seven-year experience. Singapore Med J 2004; 45(11):525-9.
(5) Paganini H, Firpo V, Villa A, Debbag R, Berberián G, Casimir L, et al. Análisis clínico y de los factores de riesgo de mortalidad de 86 casos de endocarditis infecciosa en niños y adolescentes en Argentina (1988-2000). Enferm Infecc Microbiol Clin 2004; 22 (8): 455-461.
(6) Ferrieri P, Gewitz MH, Gerber MA, Newburger JW, Dajani AS, Shulman ST, et al; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the American Heart Association Council on Cardiovascular Disease in the Young. Unique features of infective endocarditis in childhood. Circulation 2002; 105(17):2115-26.
(7) Saiman L, Prince A, Gersony WM. Pediatric infective endocarditis in the modern era. J Pediatr 1993; 122(6):847-53.
(8) Martin JM, Neches WH, Wald ER. Infective endocarditis: 35 years of experience at a children’s hospital. Clin Infect Dis 1997; 24(4):669-75.
(9) Baltimore RS. Infective endocarditis in children. Pediatr Infect Dis J 1992; 11(11):907-12.
(10) Sekido M, Takano T, Takayama M, Hayakawa H. Survey of infective endocarditis in the last 10 years: analysis of clinical, microbiological and therapeutic features. J Cardiol 1999; 33(4):209-15. Artículo en japonés.
(11) Olivera Avezuela C. Endocarditis Infecciosa: tratamiento y profilaxis. En: Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Libro de protocolos. Capítulo 41. Madrid: SECPCC, 2009. Disponible en: http://www.secardioped.org/Descargas/PyB/LP_cap41.pdf. Consulta: 10 de nov de 2012.
(12) Del Pont JM, De Cicco LT, Vartalitis C, Ithurralde M, Gallo JP, Vargas F, et al. Infective endocarditis in children: clinical analyses and evaluation of two diagnostic criteria. Pediatr Infect Dis J 1995; 14(12):1079-86.
(13) Johnson CM, Rhodes KH. Pediatric endocarditis. Mayo Clin Proc 1982; 57(2):86-94.
(14) Chiesa P, Giudice J, Dutra S, Morales J, Papone C, Gambetta JC, et al. Revisión y actualización de las pautas de profilaxis de endocarditis infecciosa en pediatría. Arch Pediatr Urug 2008; 79(3):237-40.
(15) Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994; 96(3):200-9.
(16) Carrillo G, Orjuela H, Franco J, Cassalett G, Aronga A. Endocarditis infecciosa. En: Carrillo G, Orjuela H. Cardiología pediátrica. Bogotá: McGraw-Hill Interamericana, 2000:854-61.
(17) Sanguinetti S, Raina R, Langenhin M, Prego J, Bello O. Endocarditis infecciosa aguda por estreptococo beta hemolítico de grupo A. Arch Pediatr Urug 2001; 72(Supl):79- 84.
(18) Elward K, Hruby N, Christy C. Pneumococcal endocarditis in infants and children: report of a case and review of the literature. Pediatr Infect Dis J 1990; 9(9):652-7.
(19) Choi M, Mailman TL. Pneumococcal endocarditis in infants and children. Pediatr Infect Dis J 2004; 23(2):166-71.
(20) Givner LB, Mason EO Jr, Tan TQ, Barson WJ, Schutze GE, Wald ER, et al. Pneumococcal endocarditis in children. Clin Infect Dis 2004; 38(9):1273-8.
(21) Mathew J, Anand A, Addai T, Freels S. Value of echocardiographic findings in predicting cardiovascular complications in infective endocarditis. Angiology 2001; 52(12):801-9.
(22) Enia F, Bella R, Carmina G, Celona G, Comparato C, Filippone V, et al. Prognostic value of echocardiographic finding of valvular vegetations in patients with infectious endocarditis. G Ital Cardiol 1985; 15(7):685-94. Artículo en italiano.
(23) Schünemann S, Werner GS, Schulz R, Bitsch A, Prange HW, Kreuzer H. Embolic complications in bacterial endocarditis. Z Kardiol 1997; 86(12):1017-25. Artículo en alemán.
(24) Lertsapcharoen P, Khongphatthanayothin A, Chotivittayatarakorn P, Thisyakorn C, Pathmanand C, Sueblinvong V. Infective endocarditis in pediatric patients: an eighteen-year experience from King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2005; 88 Suppl 4:S12-6.
(25) Ferreirós E, Casabé J, Nacinovich F, Swieszkowski S, Cohen H, Cortés C, et al. Endocarditis infecciosa por S. aureus en la Argentina: EIRA 2. Análisis comparativo luego de 10 años de los estudios EIRA 1 y 2. Rev Argent Cardiol 2006; 74(1):35-42.
(26) Johnson CM, Rhodes KH. Pediatric endocarditis. Mayo Clin Proc 1982; 57(2):86-94.
(27) Rohmann S, Erbel R, Görge G, Makowski T, Mohr-Kahaly S, Nixdorff U, et al. Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis. Eur Heart J 1992; 13(4):446-52.