The Clinical Features And Trend In Changes Of Infective Endocarditis In Children

?Object?To explore the clinical manifestation,laboratory examination,basic diseases,2-DE of children's IE,basic diseases,echocardiography and complications of infective endocarditis.And analyze the change trends of tiology and treatment of infective endocarditis in children by analysising the blood culture,pathogenic bacteria,antibiotic,the surgery and the risk factors of death in IE.?Methods?Retrospective analysis was done on the clinical data of 165 pediatric Infective endocarditis cases diagnosed during Jan 1999 to Dec 2015 in Shanghai Children's Medical Center.One patient reinfection for 2 times,the other patient reinfection for 7 times,so a total of 158 patients were involved.?Outcome? The common clinical manifestations were fever(98.8%).Of 158 patients with IE,congenital heart disease accounted for 151 patients(95.6%),no basic diseases in 3 patients(1.90%),blood system diseases in 3 patients(1.90%).IE with CHD,VSD was the most common,followed by PDA,TOF and valve lesion.The congenital heart diseases(95.6%)and postoperative residual anatomical abnormalities(13.9%)?residual obstruction(10.1%)?valves implanted(12.0%)were important factors that leave children susceptible to IE.80.6% intracardiac vegetations were detected detected on cardiac ultrasound,took intraoperative vegetations as gold standard,t he sensitivity and specificity of TTE were 87.4% and 62.5% in the diagnosis of vegetations.The vegetation's position was related to basic heart disease.The most common vegetations of VSD were on tricuspid(56.4%),The most common vegetations of TOF were on tricuspid valve and pulmonary valve(57.1%),77.8% PDA vegetations were on the pulmonary artery and pulmonary valve.Mitral valve lesions of vegetations were all located on mitral valves(100%).The vegetations of the aortic lesions were on the aortic valve mostly(90.9%).Heart failure was the most common complication(25.5%)in IE.21.2% IE complicated with embolization,the most common embolization was pulmonary embolism(42.9%),followed by cerebral embolism(28.6%).The blood culture positive rate was 69.8%,after the year of 2008,the blood culture positive rate has been increased to 78.8%(P < 0.01).The gram positive bacteria was still the main pathogenic bacteria(88.8%)inIE.The most common pathogenic bacteria was the streptococcus(46.6%),followed by Staphylococcus(40.6%),staphylococcus aureus was 12.7%.Staphylococcus aureus and staphylococcus aureus proportion were on the rise,streptococcus and streptococcus viridans proportion were on the decline.The sensitivity rate of all bacterias to vancomycin and rinathiazole were 100%.Resistance rates of Streptococcus to penicillin and benzyl penicillin were 100% and 76.3%.Resistance rate of streptococcus to penicillin was 10.7%,and the sensitivity rate of streptococcus to cephalosporin antibiotics was high.The drug side effects was 15.2% in IE,the main drug side effects were skin rashes,lack of granulocyte,Renal dysfunction,including 21 cases(84.0%)related to vancomycin.103 cases(62.4%)had surgery,the two groups of emergency surgery compared with elective surgery,the mortality had no significant difference(P > 0.05).The cure rate of IE was 61.8%,the effective rate of treatment was 76.3% and the in-hospital mortality of 9.7%.The cure rate of surgery with antibiotic treatment was higher than the group of pure antibiotics.And the mortality rate of surgery with antibiotic treatment was lower than the pure antibiotics group,the difference was statistically significant(P < 0.01).The cure rate of combined use of two or more antibiotics was superior to the single antibiotic treatment group,the difference was statistically significant(P < 0.05).The multi-factor logistic regression analysis found the surgery management was the protection factor of in-hospital death,cerebral embolism,heart failure and severe sepsis were independent risk factors that affect the in-hospital death of IE.?Conclusion?The congenital heart diseases and postoperative residual anatomical abnormalities?residual obstruction? valves implanted were important factors that leave children susceptible to IE.The blood culture positive rate was 68.5%,after the year of 2008,the blood culture positive rate has been increased to 77.9%.But the culture positive rate of vegetations was only 6.0%,its reference value was low.The gram positive bacteria was still the main pathogenic bacteria in IE.The most common pathogenic bacteria was the streptococcus(46.6%),followed by Staphylococcus(40.6%),staphylococcus aureus was 12.7%.Staphylococcus aureus and staphylococcus aureus proportion is on the rise,streptococcus and streptococcus viridans proportion is on the decline.The surgery management was the protection factor of in-hospital death,cerebral embolism,heart failure and severe sepsis were independent risk factors that affect the in-hospital death of IE.