Increase of fungal endocarditis in children.

BACKGROUND: Infective endocarditis (IE) is a rare and feared infection that mainly occurs in patients with underlying cardiac disease or altered function of the immune system. Recent epidemiological data on both sepsis and nosocomial infections indicate a rise in gram-negative bacterial and fungal infection, particularly in patients requiring critical care support. This study sought to characterize the change in the spectrum of IE encountered in a single pediatric tertiary care center during the last 18 years, to evaluate emergence of fungal IE and to identify contributing factors.

PATIENTS AND METHODS: Review of all cases of IE diagnosed between January 1986 and August 2003 at a single university children's hospital. Patients were distributed between two equal time periods and compared according to the era of IE diagnosis.

RESULTS: In 43 patients, 44 episodes of IE were identified with most cases occurring in children with congenital or acquired heart disease. The annual number of diagnosed cases fluctuated during the study (mean 2.4 cases/year). Blood or specimen cultures were positive in 34 cases (77%) with gram-positive organisms most frequently observed (n=20, 44.4%). Fungal IE cases (n=9, 20%) occurred preferentially during the second period (p<0.03), and were more common in children with noncardiac diseases (p=0.023). Factors associated with fungal IE were the use of broad-spectrum antibiotics (p<0.001) and the presence of an infected central venous catheter (p=0.01). Overall mortality did not differ between the two eras.

CONCLUSION: The incidence of fungal IE seems to have significantly increased in more recent years. Use of broadspectrum antibiotics for prolonged time or/and central venous catheters were identified as predisposing factors to fungal infective endocarditis.