Comparison of Infective Endocarditis between Children and Adults with Congenital Heart Disease: A 16-Year, Single Tertiary Care Center Review

Jung Eun Kwon; Yeo Hyang Kim

doi:10.14776/piv.2016.23.3.209

Journal List > Pediatr Infect Vaccine > v.23(3) > 1095931

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Kwon and Kim: Comparison of Infective Endocarditis between Children and Adults with Congenital Heart Disease: A 16-Year, Single Tertiary Care Center Review

Original Article

Pediatric Infection & Vaccine 2016; 23(3): 209-216.

Published online: 20 December 2016

DOI: https://doi.org/10.14776/piv.2016.23.3.209

Comparison of Infective Endocarditis between Children and Adults with Congenital Heart Disease: A 16-Year, Single Tertiary Care Center Review

Jung Eun Kwon, Yeo Hyang Kim

Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea.

Corresponding author (kimyhmd@knu.ac.kr)

Received 2 July 2016 Revised 24 August 2016 Accepted 29 September 2016

Abstract

Purpose

This study aimed to evaluate and compare the characteristics of infective endocarditis (IE) between children and adults with congenital heart disease (CHD) at a single tertiary care center.

Methods

In this retrospective medical record review, we extracted the demographic characteristics, diagnostic variables, and outcomes of patients diagnosed with IE and CHD between 2000 and 2016.

Results

We identified a total of 14 pediatric patients (nine male; median age at diagnosis, 3 years). Of the 14 patients, six had a history of previous open heart surgery, while four had undergone tetralogy of Fallot repair, with transannular patch or Rastelli procedure. Among the 10 children with positive blood cultures, the most common isolated organism was Staphylococcus spp. (8/10, 80%). Eleven adult patients had IE and CHD. Among the adult patients, only four were diagnosed with CHD before IE, and ventricular septal defect was the most common CHD. The most common isolated organism was Streptococcus spp. (6/11, 55%). Compared with adult patients, pediatric patients had a higher incidence of previously diagnosed CHD (P=0.001), with Staphylococcus spp. as the causative organism (P =0.027). The median duration between the onset of symptoms and diagnosis of IE was 9 days in children and 42 days in adults (P=0.012).

Conclusions

Significant differences with regard to the diagnosis and progress of IE were observed between children and adults. Ageadjusted and systematic reassessment may be necessary for the diagnosis and management of IE.

Keywords: Endocarditis, Heart defects, Congenital, Child, Adult

Figures and Tables

Table 1

The Characteristics of Pediatric Patients with Infective Endocarditis and Congenital Heart Disease

Abbreviations: OHS, open heart surgery; MPA, main pulmonary artery; ASD, atrial septal defect; MV, mitral valve; CNS, coagulase negative staphylococcus; TR, tricuspid regurgitation; TV, tricuspid valve; PDA, patent ductus arteriosus; S. viridans, Streptococcus viridans; RA, right atrium; MR, mitral regurgitation; TGA, transposition of great artery; VSD, ventricular septal defect; TOF, tetralogy of Fallot; PVR, pulmonary valve replacement; PV, pulmonary valve; TAP, transannular patch; RVOT, right ventricular outflow tract; MRSA, methicillin resistant Staphylococcus aureus; MSSA, methicillin sensitive Staphylococcus aureus; PS, pulmonary stenosis; AV, aortic valve; AS, aortic stenosis.

Table 2

The History of Congenital Heart Disease and Types of Open Heart Surgery in Each Patient with Infective Endocarditis

The History of Congenital Heart Disease and Types of Open Heart Surgery in Each Patient with Infective Endocarditis

Table 3

The Characteristics of Adult Patients with Infective Endocarditis and Congenital Heart Disease

^*Case 1 and 2 occurred 1 year apart in one patient.

^†Two blood cultures were positive in case 1 and 3.

^‡Only one blood culture was positive in case 2.

Abbreviations: OHS, open heart surgery; AV, aortic valve; AS, aortic stenosis; MRSA, methicillin resistant Staphylococcus aureus; AVR, aortic valve replacement; L. garvieae, Lactococcus garvieae; PDA, patent ductus arteriosus; PA, pulmonary artery; S. viridans, Streptococcus viridans; TOF, tetralogy of Fallot; PS, pulmonary stenosis; PR, pulmonary regurgitation; VSD, ventricular septal defect; MSSA, methicillin sensitive Staphylococcus aureus; CNS, coagulase negative Staphylococcus; MV, mitral valve; PV, pulmonary valve.

Table 4

Duration between Open Heart Surgery and Infective Endocarditis

Table 5

Causative Microorganisms Proven by Blood Culture

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