선천성 심장병을 가진 소아와 성인에서 발생한 감염성 심내막염의 비교: 1개 3차 병원의 16년간 경험
Comparison of Infective Endocarditis between Children and Adults with Congenital Heart Disease: A 16-Year, Single Tertiary Care Center Review
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study aimed to evaluate and compare the characteristics of infective endocarditis (IE) between children and adults with congenital heart disease (CHD) at a single tertiary care center. Methods: In this retrospective medical record review, we extracted the demographic characteristics, diagnostic variables, and outcomes of patients diagnosed with IE and CHD between 2000 and 2016. Results: We identified a total of 14 pediatric patients (nine male; median age at diagnosis, 3 years). Of the 14 patients, six had a history of previous open heart surgery, while four had undergone tetralogy of Fallot repair, with transannular patch or Rastelli procedure. Among the 10 children with positive blood cultures, the most common isolated organism was Staphylococcus spp. (8/10, 80%). Eleven adult patients had IE and CHD. Among the adult patients, only four were diagnosed with CHD before IE, and ventricular septal defect was the most common CHD. The most common isolated organism was Streptococcus spp. (6/11, 55%). Compared with adult patients, pediatric patients had a higher incidence of previously diagnosed CHD (P =0.001), with Staphylococcus spp. as the causative organism (P =0.027). The median duration between the onset of symptoms and diagnosis of IE was 9 days in children and 42 days in adults (P =0.012). Conclusions: Significant differences with regard to the diagnosis and progress of IE were observed between children and adults. Ageadjusted and systematic reassessment may be necessary for the diagnosis and management of IE.
Abstract
Purpose: This study aimed to evaluate and compare the characteristics of infective endocarditis (IE) between children and adults with congenital heart disease (CHD) at a single tertiary care center. Methods: In this retrospective medical record review, we extracted the demographic characteristics, diagnostic variables, and outcomes of patients diagnosed with IE and CHD between 2000 and 2016. Results: We identified a total of 14 pediatric patients (nine male; median age at diagnosis, 3 years). Of the 14 patients, six had a history of previous open heart surgery, while four had undergone tetralogy of Fallot repair, with transannular patch or Rastelli procedure. Among the 10 children with positive blood cultures, the most common isolated organism was Staphylococcus spp. (8/10, 80%). Eleven adult patients had IE and CHD. Among the adult patients, only four were diagnosed with CHD before IE, and ventricular septal defect was the most common CHD. The most common isolated organism was Streptococcus spp. (6/11, 55%). Compared with adult patients, pediatric patients had a higher incidence of previously diagnosed CHD (P =0.001), with Staphylococcus spp. as the causative organism (P =0.027). The median duration between the onset of symptoms and diagnosis of IE was 9 days in children and 42 days in adults (P =0.012). Conclusions: Significant differences with regard to the diagnosis and progress of IE were observed between children and adults. Ageadjusted and systematic reassessment may be necessary for the diagnosis and management of IE.
참고문헌 (15)
- Rushani D, "Infective endocarditis in children with congenital heart disease: cumulative incidence and predictors", Circulation, 128, pp.1412~1419 (2013)
- Di Filippo S, "Current patterns of infective endocarditis in congenital heart disease", Heart, 92, pp.1490~1495 (2006)
- Rosenthal LB, "The changing epidemiology of pediatric endocarditis at a children's hospital over seven decades", Pediatr Cardiol, 31, pp.813~820 (2010)
- Nakatani S, "Current characteristics of infective endocarditis in Japan: an analysis of 848 cases in 2000 and 2001", Circ J, 67, pp.901~905 (2003)
- 백재은, "Changes in Patient Characteristics of Infective Endocarditis with Congenital Heart Disease: 25 Years Experience in a Single Institution", Korean Circulation Journal, 44(1), pp.37~41 (2014), 대한심장학회
- 백재숙, "선천성 심질환과 관련한 감염성 심내막염의 임상 양상 변화", Korean Circulation Journal, 37(12), pp.635~640 (2007), 대한심장학회
- Li JS, "Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis", Clin Infect Dis, 30, pp.633~638 (2000)
- Kim KH, "A clinical survey of infective endocarditis", Korean Circ J, 15, pp.95~109 (1985)
- Johnson JA, "Infective endocarditis in the pediatric patient: a 60-year single-institution review", Mayo Clin Proc, 87, pp.629~635 (2012)
- Kim JS, "Clinical observation of infective endocarditis", Korean Circ J, 30, pp.166~173 (2000)
- 김성혜, "선천성 심질환을 가진 청소년 및 성인에서 발생한감염성 심내막염에 대한 임상적 고찰", Korean Circulation Journal, 36(4), pp.318~323 (2006), 대한심장학회
- Martin JM, "Infective endocarditis: 35years of experience at a children's hospital", Clin Infect Dis, 24, pp.669~675 (1997)
- Ishiwada N, "Causative organism influences clinical profile and outcome of infective endocarditis in pediatric patients and adults with congenital heart disease", Circ J, 69, pp.1266~1270 (2005)
- Elder RW, "The changing epidemiology of pediatric endocarditis", Infect Dis Clin North Am, 29, pp.513~524 (2015)
- Wilson W, "Prevention of infective endocarditis:guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group", Circulation, 116, pp.1736~1754 (2007)