All issues > Volume 47(8); 2004

Original Article

Korean J Pediatr. 2004;47(8):844-850. Published online August 15, 2004.

A Clinical Study of Infective Endocarditis in Childhood

Eun Na EN Choi¹, Jae Hun JH Kwon¹, Kyong Min KM Choi¹, Hwan Dae HD Hwang¹, Kyoung Mi KM Sin¹, Jae Young JY Choi¹, Jun Hee JH Sul¹, Dong Su DS Kim¹

¹Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea

Correspondence Dong Su DS Kim ,Email: 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 α-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.

Keywords :Endocarditis, Infection, Antibiotics