Infective Endocarditis in Children in Italy from 2000 to 2015

ABSTRACT

Objective: The Italian Society for Pediatric Infectious Diseases created a registry on children with infective endocarditis (IE) hospitalized in Italy.

Methods: A cross-sectional survey was conducted on patients hospitalized due to IE in Italian paediatric wards between January 1, 2000, and June 30, 2015.

Results: Over the 15-year study period, 47 IE episodes were observed (19 males; age range, 2-17 years). Viridans Streptococci were the most common pathogens among patients with predisposing cardiac conditions and Staphylococcus aureus among those without (37.9% vs. 5.5%, p = 0.018, and 6.9% vs. 27.8%, p = 0.089, respectively). Six of the 7 (85.7%) S. aureus strains were methicillin-resistant. The majority of patients with and without predisposing cardiac conditions recovered without any complications.

Conclusion: In Italy, paediatric IE develops without any previous predisposing factors in a number of children, methicillin-resistant S. aureus has emerged as a common causative agent and the therapeutic approach is extremely variable.

KEYWORDS:

• antibiotics
• anti-infective therapy
• congenital heart disease
• infective endocarditis
• Staphylococcus aureus
• viridans Streptococci

Financial & competing interests disclosure

This study was supported in part by grants from the Italian Ministry of Health (Ricerca Corrente 2015 850/01, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• In Italy, rheumatic heart disease is no longer a common predisposing factor for infective endocarditis (IE) development.

• Despite the fact that congenital heart disease remains a substantial cause of IE in a number of children, IE often develops without any predisposing factors.

• viridans streptococci are the main etiological agents in children with predisposing cardiac disease, whereas methicillin-resistant S. aureus has emerged as a common causative agent in children without predisposing cardiac disease.

• Treatment options recommended for pediatric IE did not follow precise therapeutic schemes, and therapeutic approaches are extremely variable.

• Considering the rate of mortality in the absence of predisposing cardiac disease, specific therapeutic management protocols for IE in pediatric patients are urgently needed.