Trends of Childhood Infective Endocarditis in Israel with Emphasis on Children Under 2 Years of Age

This study retrospectively analyzed the characteristics of infective endocarditis (IE) in children in light of recent advances in pediatric cardiology. We evaluated 25 consecutive patients with IE from 1980 to 1991 at a tertiary Children's Medical Center in Israel. The incidence of IE increased significantly over the second half of the study period, owing mainly to an increase in the number of patients less than 2 years old. Concomitantly, the causative microorganisms changed considerably, with a decrease in viridans streptococci, an increase in staphylococci and other uncommon causes of IE, and increased antibiotic resistance. Children under the age of 2 years, previously considered uncommon IE patients, accounted for 47% of the IE cases during the second half of the study period. The infection often (78%) appeared in children with complex congenital heart diseases, commonly after early palliative or definitive cardiac surgery. Infants who underwent systemic-to-pulmonary shunting, especially with implantation of foreign materials, were at highest risks. IE was more often hospital-acquired (56% versus 6%) and acute (56% versus 44%) in the younger children than in the older ones and often lacked the typical clinical presentation of the disease. In addition, uncommon causative organisms were noted more frequently (67% versus 13%; p= 0.009) in the younger group. The study shows a significant increase in IE in infants and young children with distinctive underlying conditions, clinical presentation, and microbiologic findings, all of which should be considered currently for the diagnosis and treatment of pediatric IE.