202 THE CHANGING SPECTRUM OF PEDIATRIC INFECTIVE ENDOCARDITIS (IE): AN ANALYSIS OF 26 CASES AT YALE-NEW HAVEN HOSPITAL, 1970–1979

Abstract

The last decade has been marked by an increased survival of children with complex cyanotic heart lesions, increasing employment of open heart surgery and surgery requiring the insertion of prosthetic material, and an increased utilization of indwelling central catheters in the critically ill patient. To investigate whether these and other factors have contributed to a change in the natural history of IE in children we analyzed all 26 cases of pediatric IE seen at Yale 1970 through 1979.

Four important differences from previous series were noted. 1) A larger proportion of cases arose post-operatively, 14/26 (54%) of which 11 were ≤ 6 mos. post-op. (2) Staphylococci were not the predominant pathogens among post-surgical or catheter-related cases (3/13). Other pathogens were alpha Strep ·4, gr D Strep., Enterobacter, Klebsiella and Serratia. (3) IE associated with prosthetic material carried an unexpectedly favorable survival , 86% (6/7) compared with an 81% survival for the entire group. Moreover, all survivors of IE with prosthetic material were cured by medical regimens alone. (4) All episodes of IE occurring in previously normal hearts occurred in patients with indwelling central catheters and also carried the worst prognosis in this series (mortality 2/3).

We conclude that pediatric IE continues to be an evolving disease and that this is a reflection of new approaches to children with complex congenital heart disease and of acute care of critically ill children.

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