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Congenital heart disease increased risk for infective endocarditis
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Congenital heart disease in children is the most common risk factor for infective endocarditis, and a recent study has described additional clinical predictors of infective endocarditis in this population.
Researchers found that prolonged bacteremia, thrombocytopenia and C-reactive protein greater than 10 mg/dL possibly serve as diagnostic adjuncts for infective endocarditis.
“Congenital heart disease occurs in up to 75/1,000 live births and often requires complex surgical correction,” J. Chase McNeil, MD, of Baylor College of Medicine, and colleagues wrote. “As a result of their altered hemodynamics, presentation at an extremely young age, need for surgery, and often prolonged hospitalization, children with [congenital heart disease] are at risk for health care-associated infections. Furthermore, [congenital heart disease] is the most common predisposing factor for infective endocarditis in the pediatric population.”
The study included children with a history of congenital heart disease (CHD) and Staphylococcus aureus infections included in a surveillance study of S. aureus infections at Texas Children’s Hospital.
Researchers found that 248 S. aureus infections occurred in 216 children with CHD. Methicillin resistance was found in 53.6% of isolates. Of those cases, 28.2% were caused by surgical site infections and 20.4% were caused by bacteremia. Bacteremia was associated with infective endocarditis in 29.5% of the episodes.
Infective endocarditis was most often associated with prolonged bacteremia, thrombocytopenia and a higher C-reactive protein compared with uncomplicated bacteremia. The researchers also examined the prevalence of the Staphylococcal gene qacA/B, conferring tolerance to antiseptics, in this population. The gene qacA/B was found in 16.9% of isolates and was associated with bacteremia and prolonged hospitalization.
“In summary, S. aureus represents a significant cause of morbidity among patients with CHD,” researchers wrote. “For patients with bacteremia, there is a high risk of [infective endocarditis], particularly with prolonged bacteremia, elevated inflammatory markers, and thrombocytopenia. Finally, chlorhexidine-tolerant organisms are increasing in prevalence and are associated with adverse clinical outcomes. Large scale, longitudinal studies are needed to further understand the risk of invasive infections in these patients as well as the implications of qacA/B-positive organisms.”
Disclosure: The study was funded in part by Pfizer.
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