Yıl: 2020 Cilt: 42 Sayı: 2 Sayfa Aralığı: 231 - 239 Metin Dili: İngilizce DOI: 10.20515/otd. 569875 İndeks Tarihi: 01-04-2021

Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey

Öz:
In this study, we retrospectively evaluated the underlying risk factors, clinical and laboratory findings, treatmentapproaches, anticoagulation therapy experiences, and the complications that arose during the follow-up of patients diagnosed withinfective endocarditis in our clinic between 2010–2018. Eleven patients with infective endocarditis were evaluated. The relevantfeatures of the patients whom developed complications, given anticoagulant therapy in addition to antibiotherapy, underwent cardiacsurgery, and showed a mortality course were determined. The youngest patient was 7 months old and the oldest was 14 years old(7.5 ± 4.6 years). All of the cases had congenital heart anomalies and there were no cases with rheumatic heart disease. A total ofeight patients had embolic findings. Echocardiography showed vegetation in nine patients. In addition to antibiotherapy,anticoagulant treatment was applied to 2 patients. The most common microorganism in the blood culture was coagulase negativestaphylococci with five cases. Five patients underwent early surgical treatment, one patient died due to multiple organ failure causedby systemic embolization, and one patient died due to sudden hemodynamic instability in the first week of follow-up. Infectiveendocarditis is a serious disease with life-threatening complications. In children, the main underlying risk factor is congenital heartdisease unlike with adults. Once the diagnosis is made, appropriate antibiotherapy should be initiated as soon as possible to preventseptic embolism and mortality. The role of anticoagulation in the prevention of embolism and the treatment of ischemic strokeremains controversial.
Anahtar Kelime:

I nfektif Endokarditli Çocuklarda Klinik Ö zellikler, Tedavi Yaklaşımları ve Komplikasyonlar: Tu rkiye’den Tek Merkez Deneyimi

Öz:
Bu çalışma ile 2010-2018 yılları arasında kliniğimizde infektif endokardit tanısı almış hastalar altta yatan risk faktörleri, klinik ve laboratuvar bulguları, tedavi yaklaşımları, antikoagülan tedavi ile ilgili deneyimler ve izlemde ortaya çıkan komplikasyonlar açısından geriye dönük olarak değerlendirildi. İnfektif endokardit tanısı alan 11 hastaya ulaşıldı. Komplikasyon meydana gelen, antibiyoterapiye ilave olarak antikoagülan tedavi uygulanan, cerrahiye verilen ve mortal seyir gösteren hastaların özellikleri saptandı. En küçük hasta 7 aylık, en büyüğü 14 yaşındaydı (7.5 ± 4.6 yıl). Olguların 10’unda infektif endokardit için risk oluşturan konjenital kalp anomalisi mevcut olup, romatizmal kalp hastalığına sahip olgu yoktu. Toplam sekiz olguda embolik bulgular saptandı. Dokuz olguda ekokardiyografide vejetasyon izlendi. İki olguda antibiyoterapiye ilave olarak antikoagülan tedavi uygulandı. Koagülaz negatif stafilakok, beş olgu ile kan kültüründe en sık üreyen mikroorganizma idi. Beş olguya erken cerrahi tedavi uygulandı. Bir olgu sistemik embolizasyona bağlı gelişen çoklu organ yetmezliği, bir olgu ise izleminin birinci haftasında aniden gelişen hemodinamik bozulma nedeniyle öldü. İnfektif endokardit hayatı tehdit eden komplikasyonlar ile seyredebilen ciddi bir hastalıktır. Erişkinlerden farklı olarak, çocuklarda altta yatan başlıca risk faktörü konjenital kalp hastalıklarıdır. Tanı sonrasında, septik embolizasyon ve mortalitenin önlenebilmesi için olabildiğince erken uygun antibiyoterapi başlanmalıdır. Embolizmin önlenmesi ve iskemik inme tedavisinde antikoagülasyonun yeri ise tartışmalı bir konudur.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Bode-Thomas F, Ige OO, Yilwan C. Childhood acquired heart diseases in Jos, north central Nigeria. Niger Med J. 2013 ;54:51-8.
  • 2. Thornhill M.H, Jones S, Prendergast B, et al. Quantifying infective endocarditis risk in patients with predisposing cardiac conditions. Eur Heart J. 2018; 39:586–95.
  • 3. Saiman L, Prince A, Gersony WM. Pediatric infective endocarditis in modern era. J Pediatr. 1993;122:847-53.
  • 4. Day MD, Gauvreau K, Shulman S, Newburger JW. Characteristics of children hospitalized with infective endocarditis. Circulation 2009;119:865- 70.
  • 5. Singh Y, Ganjoo N. Infective endocarditis in children. Paediatrics and child health 2017;27:68- 74.
  • 6. Elbey MA, Akdağ S, Kalkan ME, Kaya MG, Sayın MR, Karapınar H et all. A multicenter study on experience of 13 tertiary hospitals in Turkey in patients with infective endocarditis. Anadolu Kardiyol Derg. 2013;13:523-7.
  • 7. Tavlı V, Çevik B.Ş, Saritaş T, Meşe T. İnfektif endokardit saptanan çocuklarda klinik, laboratuvar ve ekokardiyografik parametrelerin retrospektif değerlendirilmesi. Gazi Tıp Dergisi.2009;20:47-50.
  • 8. Hızlı S, Bilgic A. Evaluation of pediatric patients with infective endocarditis: an 11-year experience. Arch Turk Soc Cardiol 2005;33:141-48.
  • 9. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et all. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J. 2015 21;36:3075-128.
  • 10. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. 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. 2007;116:1736–54.
  • 11. Ahmadi A, Daryushi H. Infective endocarditis in children: A 5 year experience from Al-Zahra Hospital, Isfahan, Iran. Adv Biomed Res. Published online 2014 /2277-9175.145715.
  • 12. Johnson A.J, Boyce G.T, Cetta F, Steckelberg M.J, Johnson N.J. Infective endocarditis in the pediatric patient:A 60-year single-institution review. Mayo Clin Proc. 2012;87:629-35.
  • 13. Şimşek-Yavuz S. İnfektif endokardit: güncel bilgiler. Klimik Dergisi 2015;28:46-67.
  • 14. Rushani D, Kaufman J.S, Ionescu-Ittu R, Mackie A.S, Pilote L, Therrien J, Marelli A.J. Infective Endocarditis in Children With Congenital Heart Disease Cumulative Incidence and Predictors. Circulation. 2013;128:1412-19.
  • 15. Bizmark R.S, Chang R.R, Tsugawa Y, Zangwill K.M, Kawachi I. Impact of AHA's 2007 guideline change on incidence of infective endocarditis in infants and children. Am Heart J 2017;189:110-9.
  • 16. Pant S, Patel NJ, Deshmukh A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol 2015;65:2070-6.
  • 17. Thornhill MH, Dayer MJ, Forde JM, et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. Br Med J 2011;342:2392-8.
  • 18. Dayer MJ, Jones S, Prendergast B, et al. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet 2015;385:1219-28.
  • 19. Topan A, Carstina D, Slavcovici A, Rancea R, Capalneanu R, Lupse M. Assesment of the duke criteria for the diagnosis of infective endocarditis after twenty years. An analysis of 241 cases. Clujul Med. 2015;88:321-6.
  • 20. Jomaa W,Ben Ali I,Abid D,Hajri Ernez S,Abid L,TrikiF,etal.Clinical features and prognosis of infe ctive endocarditis in children: insights from a Tunisian multicentre registry. Arch Cardiovasc Dis. 2017;110:676-81.
  • 21. Nishizaki Y, Yamagami S, Joki Y, Takahashi S, Sesoko M, Yamashita H, et al. Japanese features of native valve endocarditis caused by coagulasenegative staphylococci: case reports and a literature review. Intern Med 2013;52:567-72.
  • 22. Eiland EH, Edwards JD, Hassoun A. Coagulasenegative staphylococci-associated native valve endocarditis: comparative findings within a large cohort study and a community hospital. J Am Pharm Assoc (2003). 2008;48:438.
  • 23. García de la Mària C, Cervera C, Pericàs JM, Castañeda X, Armero Y, Soy D, et al. Epidemiology and prognosis of coagulase-negative staphylococcal endocarditis:impact of vancomycin minimum inhibitory concentration. PLoS One 2015;10:0125818.
  • 24. Prendergast BD, Tornos P. Surgery for infective endocarditis: who and when? Circulation. 2010;121:1141-52.
  • 25. Lee SJ, Oh SS, Lim DS, Hong SK, Choi RK, Park JS. Usefulness of anticoagulant therapy in the prevention of embolic complications in patients with acute infective endocarditis. Biomed Res Int. 2014; Epub.
  • 26. Rasmussen RV, Snygg-Martin U, Olaison L, Buchholtz K, Larsen CT, Hassager C, Bruun NE. Major cerebral events in Staphylococcus aureus infective endocarditis: is anticoagulant therapy safe? Cardiology. 2009;114:284-91.
  • 27. Preston A.H, Williams S, Archer J. A review of the role of anticoagulation for patients with infective endocarditis and embolic stroke. Clinical Case Reports 2016; 4:513–16.
APA Kosger P, Keskin T, Kiztanir H, Ucar B (2020). Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. , 231 - 239. 10.20515/otd. 569875
Chicago Kosger Pelin,Keskin Tugcem,Kiztanir Hikmet,Ucar Birsen Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. (2020): 231 - 239. 10.20515/otd. 569875
MLA Kosger Pelin,Keskin Tugcem,Kiztanir Hikmet,Ucar Birsen Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. , 2020, ss.231 - 239. 10.20515/otd. 569875
AMA Kosger P,Keskin T,Kiztanir H,Ucar B Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. . 2020; 231 - 239. 10.20515/otd. 569875
Vancouver Kosger P,Keskin T,Kiztanir H,Ucar B Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. . 2020; 231 - 239. 10.20515/otd. 569875
IEEE Kosger P,Keskin T,Kiztanir H,Ucar B "Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey." , ss.231 - 239, 2020. 10.20515/otd. 569875
ISNAD Kosger, Pelin vd. "Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey". (2020), 231-239. https://doi.org/10.20515/otd. 569875
APA Kosger P, Keskin T, Kiztanir H, Ucar B (2020). Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. Osmangazi Tıp Dergisi, 42(2), 231 - 239. 10.20515/otd. 569875
Chicago Kosger Pelin,Keskin Tugcem,Kiztanir Hikmet,Ucar Birsen Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. Osmangazi Tıp Dergisi 42, no.2 (2020): 231 - 239. 10.20515/otd. 569875
MLA Kosger Pelin,Keskin Tugcem,Kiztanir Hikmet,Ucar Birsen Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. Osmangazi Tıp Dergisi, vol.42, no.2, 2020, ss.231 - 239. 10.20515/otd. 569875
AMA Kosger P,Keskin T,Kiztanir H,Ucar B Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. Osmangazi Tıp Dergisi. 2020; 42(2): 231 - 239. 10.20515/otd. 569875
Vancouver Kosger P,Keskin T,Kiztanir H,Ucar B Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey. Osmangazi Tıp Dergisi. 2020; 42(2): 231 - 239. 10.20515/otd. 569875
IEEE Kosger P,Keskin T,Kiztanir H,Ucar B "Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey." Osmangazi Tıp Dergisi, 42, ss.231 - 239, 2020. 10.20515/otd. 569875
ISNAD Kosger, Pelin vd. "Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey". Osmangazi Tıp Dergisi 42/2 (2020), 231-239. https://doi.org/10.20515/otd. 569875