Infective endocarditis in children: a 23-year experience at a Southern African tertiary institution

Meera Ooka, Antoinette Cilliers

Abstract

Background: There is a paucity of data regarding infective endocarditis (IE) in children, particularly in low-to-middle-income settings, with minimal recent data from Sub-Saharan Africa.
Objectives: To determine the demographic and clinical profiles of paediatric patients with IE at the Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa.
Methods: A retrospective descriptive study of all paediatric patients diagnosed with IE between 1993 and 2015. Demographic data, the presence of congenital or acquired structural heart disease and other risk factors, blood culture results and complications were recorded and analysed using basic statistical methods.
Results: 183 patients were included (median age 31.2 months). Ninety-seven patients (53%) had underlying congenital heart disease (CHD), 26 had rheumatic heart disease (14.2%), and 45 (24%) were identified with structurally normal hearts. Underlying sepsis (37.8%), central venous catheters (CVC) (31.2%), prematurity (15.6%) and human immunodeficiency virus (13.3%) were found to be risk factors in the group with normal hearts. Staphylococcus aureus and Streptococcus viridans were the most common pathogens. Complications were documented in 103 (56.3%) patients. These included cardiac failure (CF), worsening valve lesions, vascular complications (embolisation and mycotic aneurysm formation), other manifestations of sepsis, surgery required to treat complications and death. The overall mortality rate was 23.5%. CF and vascular complications were associated with a high risk of mortality.
Conclusion: CHD is the most common association with IE, followed by structurally normal hearts in premature infants and patients with CVC. The complication rate of 56% and 24% mortality rate highlight the devastating outcomes of IE.