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Endocarditis infecciosa nativa en pediatría: enfoque clínico cardiológico / Native valve infective endocarditis in children: From the focus of clinical cardiology
Lafuente, M V; Blando, J; Villalba, C; Stelmaszewski, E; Oribe, R; Mouratian, M; Capelli, H; Di Santo, M.
Affiliation
  • Lafuente, M V; Hospital de Pediatría Juan P. Garrahan. Servicio de Cardiología Infantil. Buenos Aires. AR
  • Blando, J; Hospital de Pediatría Juan P. Garrahan. Servicio de Cardiología Infantil. Buenos Aires. AR
  • Villalba, C; Hospital de Pediatría Juan P. Garrahan. Servicio de Cardiología Infantil. Buenos Aires. AR
  • Stelmaszewski, E; Hospital de Pediatría Juan P. Garrahan. Servicio de Cardiología Infantil. Buenos Aires. AR
  • Oribe, R; Hospital de Pediatría Juan P. Garrahan. Servicio de Cardiología Infantil. Buenos Aires. AR
  • Mouratian, M; Hospital de Pediatría Juan P. Garrahan. Servicio de Cardiología Infantil. Buenos Aires. AR
  • Capelli, H; Hospital de Pediatría Juan P. Garrahan. Servicio de Cardiología Infantil. Buenos Aires. AR
  • Di Santo, M; Hospital de Pediatría Juan P. Garrahan. Servicio de Cardiología Infantil. Buenos Aires. AR
Med. infant ; 26(2): 85-91, Junio 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1009024
Responsible library: AR305.1
Localization: AR305.1
RESUMEN

Objetivos:

Analizar las características demográficas, clínicas, microbiológicas, evolución y factores de riesgo de morbimortalidad asociados a la endocarditis de válvula nativa (EIN) en pacientes (p) pediátricos. Población y

métodos:

Se evaluaron 176 p con EIN, divididos en grupo I <3meses (27p) y grupo II >3meses (149p).

Resultados:

Grupo I el 66% tenía corazón sano. El microorganismo más frecuente fue Staphylococcus aureus (44,4%). Afectación derecha (77,8%-p<0,0001). Evento principal infección no controlada (INC) (52%, p=0,0009) y asociada a Candida (p<0,00001). Se indicó tratamiento quirúrgico a 10 p (37%). Mortalidad 29,6%(8p). Grupo II el 57% presentaba cardiopatía previa. Microorganismos prevalentes S.aureus (49,1%) y estreptococos del grupo viridans (22,5%). Hubo compromiso predominantemente izquierdo (p=0,001). Eventos embolias sistémicas (36,2%-p=0,01), perforación valvular (51%-p=0,0005), insuficiencia cardíaca (26%-p=0,03) e INC (21,5%). La embolia sistémica se asoció a S.aureus (p=0,01). El 36,2% requirió cirugía. Mortalidad 6,7% (10p). En el análisis univariado la mortalidad se asoció a edad <3meses (p=0,0003), INC (p=0,002) y S.aureus (p=0,03). En el multivariado la mortalidad se relacionó a edad < 3meses (OR7,50 ­IC95%1,77­31,69) y a INC (OR4,2-IC95%1,16­15,29).

Conclusiones:

La EN se presentó en pacientes con corazón sano en el 50% de los casos. El microorganismo más frecuente fue S.aureus. En los <3 meses la infección no controlada fue la complicación más frecuente asociada a Candida, con afectación predominante de cavidades derechas. Los >3meses tuvieron mayor prevalencia de perforación valvular izquierda asociada a embolias sistémicas e insuficiencia cardíaca. El 35% de los p requirió cirugía. Los predictores de mortalidad fueron la edad <3meses y la INC.
ABSTRACT

Objectives:

To analyze demographic, clinical, and microbiological, outcome, and morbidity and mortality risk factors associated with native valve endocarditis (NVE) in pediatric patients (p). Population and

methods:

176 p with NVE were evaluated and divided into group I <3 months (27p) and group II >3 months (149p).

Results:

Group I 66% had a healthy heart. The most common microorganism was Staphylococcus aureus (44.4%). Right-sided involvement (77.8%-p<0.0001). Main event Uncontrolled infection (UCI) (52%, p-0.0009) and association with Candida (p<0.00001). Surgical treatment was indicated in 10 p (37%). Mortality was 29.6% (8p). Group II 57% had previous heart disease. Prevalent microorganisms S. aureus (49.1%) and viridans group streptococci ( (22.5%). Left-sided involvement predominated (p-0.001). Events systemic embolism (36.2%-p-0.01), valve perforation (51%-p-0.0005), heart failure (26%-p-0.03), and UCI (21.5%). Systemic embolism was associated with S. aureus infection (p-0.01). 36.2% required surgery. Mortality was 6.7% (10p). In univariate analysis, mortality was associated with age <3 months (p-0.0003), UCI (p-0.002), and S. aureus infection (p-0.03). In multivariate analysis, mortality was related to age <3 months (OR7.50 ­ 95% CI1.77­31.69) and UCI (OR4.2 -95% CI1.16­15.29).

Conclusions:

NVE was observed in patients with a healthy heart in 50% of cases. The most common microorganism found was S. aureus. In the <3 months group, uncontrolled infection was the most common complication associated with Candida, predominantly affecting the right side. The >3 months group had a higher prevalence of left-valve perforation associated with systemic embolism and heart failure. 35% of p required surgery. Predictors of mortality were age <3 months and UC (AU)
Subject(s)

Full text: Available Collection: International databases Health context: SDG3 - Health and Well-Being / SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases / SDG3 - Target 3.2 Reduce avoidable death in newborns and children under 5 Health problem: Target 3.2: Reduce avoidable death in newborns and children under 5 / Cardiovascular Disease / Other circulatory Diseases / Noncommunicable Diseases Database: LILACS Main subject: Staphylococcus aureus / Viridans Streptococci / Endocarditis / Heart Valve Diseases Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Child / Child, preschool / Humans / Infant / Infant, Newborn Language: Spanish Journal: Med. infant Journal subject: Pediatrics Year: 2019 Document type: Article Affiliation country: Argentina Institution/Affiliation country: Hospital de Pediatría Juan P. Garrahan/AR
Full text: Available Collection: International databases Health context: SDG3 - Health and Well-Being / SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases / SDG3 - Target 3.2 Reduce avoidable death in newborns and children under 5 Health problem: Target 3.2: Reduce avoidable death in newborns and children under 5 / Cardiovascular Disease / Other circulatory Diseases / Noncommunicable Diseases Database: LILACS Main subject: Staphylococcus aureus / Viridans Streptococci / Endocarditis / Heart Valve Diseases Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Child / Child, preschool / Humans / Infant / Infant, Newborn Language: Spanish Journal: Med. infant Journal subject: Pediatrics Year: 2019 Document type: Article Affiliation country: Argentina Institution/Affiliation country: Hospital de Pediatría Juan P. Garrahan/AR
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