Abstract
Background:
Infective endocarditis (IE) is a rare and feared infection that mainly occurs in patients with underlying cardiac disease or altered function of the immune system. Recent epidemiological data on both sepsis and nosocomial infections indicate a rise in gram–negative bacterial and fungal infection, particularly in patients requiring critical care support. This study sought to characterize the change in the spectrum of IE encountered in a single pediatric tertiary care center during the last 18 years, to evaluate emergence of fungal IE and to identify contributing factors.
Patients and Methods:
Review of all cases of IE diagnosed between January 1986 and August 2003 at a single university children’s hospital. Patients were distributed between two equal time periods and compared according to the era of IE diagnosis.
Results:
In 43 patients, 44 episodes of IE were identified with most cases occurring in children with congenital or acquired heart disease. The annual number of diagnosed cases fluctuated during the study (mean 2.4 cases/year). Blood or specimen cultures were positive in 34 cases (77%) with gram–positive organisms most frequently observed (n = 20, 44.4%). Fungal IE cases (n = 9, 20%) occurred preferentially during the second period (p < 0.03), and were more common in children with noncardiac diseases (p = 0.023). Factors associated with fungal IE were the use of broad–spectrum antibiotics (p < 0.001) and the presence of an infected central venous catheter (p = 0.01). Overall mortality did not differ between the two eras.
Conclusion:
The incidence of fungal IE seems to have significantly increased in more recent years. Use of broadspectrum antibiotics for prolonged time or/and central venous catheters were identified as predisposing factors to fungal infective endocarditis.
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Tissières, P., Jaeggi, E.T., Beghetti, M. et al. Increase of Fungal Endocarditis in Children. Infection 33, 267–272 (2005). https://doi.org/10.1007/s15010-005-4122-4
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DOI: https://doi.org/10.1007/s15010-005-4122-4