Infectious Endocarditis in Children: One Institution's Analysis

1Children's Hospital of Richmond at VCU, Richmond, VA
2Children's Hospital of Richmond at VCU, Richmond, VA

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 478

Case Presentation:

Infectious endocarditis (IE) is a serious and sometimes fatal illness that affects very few children. It is typically seen in patients with underlying medical conditions, especially heart defects or indwelling central venous catheters (CVC). It is very uncommon to see IE in children younger than 1 year of age. It was the goal of this review to investigate the characteristics of all children diagnosed with IE in the last 5 years at Children's Hospital of Richmond (CHoR) at VCU Health Systems. The index case was a 7‐month‐old full‐term male with no previous medical history was admitted after several days of fevers and positive blood culture for methicillin‐sensitive S. aureus (MSSA). On hospital day 2, the patient was noted to have a new 2/6 systolic ejection murmur. A 2D echocardiogram revealed vegetation on the aortic valve, but no structural heart defects were noted. He completed a 6‐week course of nafcillin, and a repeat echocardiogram 2 months after the diagnosis showed resolution of the vegetation.

Discussion:

This was a retrospective review of all patients, birth to 18 years of age, who were diagnosed with IE and treated at CHoR at VCU Health Systems in the last 5 years. Because the small sample size (n = 17), no statistical analyses were performed. Of the 17 patients identified by ICD‐9 codes for IE, only 10 were included as they were true cases of IE. Our index case was included as 1 of the 10 in our sample. Male:female ratio was 1:1, as there were 5 patients of each sex. Patients with structural heart defects were 2 of 17 (11%). Those 2 patients also had CVCs. Patients with CVCs were 7 of 17 (41%). There was 1 patient who had a ventriculo‐atrial shunt with thrombus and vegetation in the SVC/RA junction at the location of the shunt tip. Two patients, who did not have central lines or underlying heart defects, had recently undergone abdominal surgery. One 14‐year‐old male was previously healthy and developed MSSA bacteremia that caused his endocarditis. In this review, coagulase‐negative staphylococcus and MSSA were 2 of 17 each (11%).

Conclusions:

This review found 10 previous cases of IE in patients from birth to 18 years of age from the last 5 years at CHoR at VCU Health Systems. Only 2 of the patients, one including the index case, were healthy with no underlying medical conditions or CVCs. There were no other previously healthy patients younger than a year old. In this review the most common risk factor was having a CVC. There was no male to female difference. There was a slight predominance for younger patients but that appeared to be due to the number of CVCs in NICU patients.

To cite this abstract:

Lee C, Beasley G. Infectious Endocarditis in Children: One Institution's Analysis. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 478. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/infectious-endocarditis-in-children-one-institutions-analysis/. Accessed November 12, 2019.

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