Prithvi Raj Sendi, MD
Nicklaus Children's Hospital
Miami, Florida
Disclosure information not submitted.
Paul Martinez, MD
Assistant Professor
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Madhuradhar Chegondi, MD
Clinical Associate Professor, Division of Pediatric Critical Care Medicine
University of Iowa Stead Family Childrens's Hospital
Iowa City, IA, United States
Disclosure information not submitted.
Jake Meyer
Research Volunteer
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM
Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Title: The Prevalence of Infective Endocarditis in Hospitalized Children in the US from 1997 – 2016
Introduction: Infective endocarditis (IE) is an uncommon form of acquired heart disease in children which carries a high mortality. The epidemiology and outcomes of IE has changed over time due to changes in risk factors, implementation of AHA guidelines and infectious etiology. The aim of this study was to explore and trend the prevalence of IE, influence of age, congenital heart disease (CHD), infectious etiology, and interventions in patients with IE from 1997 – 2016.
Methods: A retrospective analysis using the Healthcare Cost and Utilization Project’s Kids’ Inpatient
Database from the years 1997-2016 was performed. Hospitalized patients from birth to 20 years of age were selected. Patients with the diagnosis of IE were selected using respective ICD-9 or ICD-10 codes. Univariate and multivariable analyses were performed to analyze data in SPSS. Trend analysis (StatCalc, CDC) was performed to evaluate the changes in prevalence of IE, CHD, infectious etiology, and mortality.
Results: Among 48,866,273 discharges from 1997-2016, 11,408 children were hospitalized with the diagnosis of IE (2/10,000 discharges). Trend analysis demonstrated an increase in prevalence of IE from 1997-2016 (p < 0.001). The majority of the children with IE were early adolescents (12-18 years) (28.6%), from metropolitan counties (38.5%) and were treated at teaching hospitals (80.2%). Among patients with IE, the prevalence of staphylococcal, gram negative and fungal infections increased (p < 0.001) while that of streptococcal infection decreased (p < 0.001). CHD was prevalent in 49.8% of the neonates with IE and in 35.3% of all other age groups. The prevalence of CHD in patients with IE was unchanged over time (p=0.8). Mortality from IE was 5.3%. Multivariable analysis demonstrated that mortality was significantly higher when associated with CPR (OR:9.8, 95%CI:6.1-15.7), invasive mechanical ventilation (OR:6.9, 95%CI:5.4-8.7), ECMO (OR:5.3, 95%CI: 3.3-8.6), and hemodialysis (OR:1.7, 95%CI:1.1-3.0). Mortality from IE decreased between 1997 and 2016 (p < 0.001).
Conclusion: The prevalence of IE increased between 1997 and 2016 in the U.S., while the associated mortality decreased during that same period. In addition, the microbial etiology of IE changed during this period.