Korean J Pediatr.  2004 Aug;47(8):844-850.

A Clinical Study of Infective Endocarditis in Childhood

Affiliations
  • 1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea. dskim6634@yumc.yonsei.ac.kr

Abstract

PURPOSE
Advances in the treatment of congenital heart disease and a decline in the incidence of rheumatic fever has led to changes in the causative organisms and the clinical outcome of infective endocarditis(IE). We sought to analyze the clinical outcome, prognostic factors, causative organisms and corresponding antibiotic sensitivity in IE.
METHODS
Retrospective analysis of medical records of 104 children diagnosed and treated with IE at Severance Hospital, Yonsei University College of Medicine from January 1986 to June 2003 was undertaken. According to the Duke criteria, 55 patients were classified into the definite group(DG) and possible group(PG).
RESULTS
Thirty one cases(56.4%) fulfilled the criteria for the definite group in the Duke criteria, whereas 24 cases(43.6%) fulfilled the criteria for the possible group. The most common chief complaint on admission was fever(93%). The most common infecting organism was Staphylococcus aureus, which was found in 14 cases(48.3%). Three cases(21.4%) of this organism were methicillin- resistant S. aureus(MRSA). Other causative organisms were alpha-streptococcus(seven cases, 24.1%), Staphylococcus epidermidis(three cases, 10.3%), Citrobacter freundii(one case, 3.8%), Enterococcus faecium(one case, 3.4%) and Candida albicans(three cases, 10.3%). Penicillin-resistant organisms were found in 90.5%(19/21) of total cases and the most sensitive antibiotics were vancomycin(13/13, 100 %) and teicoplanin(12/12, 100%). One case of IE due to MRSA unresponsive to vancomycin was treated with Arbekacin.
CONCLUSION
The incidence of IE caused by S. aureus, especially MRSA, is increasing. Multi-drug resistant organisms are also emerging as a frequent cause of IE. Thus, in patients strongly suspected of having IE in patients with underlying heart disease, glycopeptides such as vancomycin combined with aminoglycosides should be considered, and if fever and positive blood cultures continue despite treatment with glycopeptides, a consideration of the use of new antibiotics may improve the treatment results.

Keyword

Endocarditis; Infection; Antibiotics

MeSH Terms

Aminoglycosides
Anti-Bacterial Agents
Candida
Child
Citrobacter
Endocarditis*
Enterococcus
Fever
Glycopeptides
Heart Defects, Congenital
Heart Diseases
Humans
Incidence
Medical Records
Methicillin-Resistant Staphylococcus aureus
Retrospective Studies
Rheumatic Fever
Staphylococcus
Staphylococcus aureus
Vancomycin
Aminoglycosides
Anti-Bacterial Agents
Glycopeptides
Vancomycin
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