Características clínicas e demográficas dos pacientes com endocardite infecciosa no Serviço de Cardiologia Pediátrica de um hospital terciário em Salvador-Bahia

Abstract

Clinical and demographic characteristics of infective endocarditis in a cardiac pediatric service of a tertiary referral hospital in Salvador, Bahia, Brazil. Background: Infective Endocarditis (IE) is an infectious process of the endocardial surface of the heart, which affects mainly the heart valves. The etiology of the infection might be bacterial, viral or fungal, and has been shown to have higher incidence rates in the pediatric population, being considered an important cause of mortality. Objectives: Describe the main clinical and demographic characteristics of patients with IE in a cardiac pediatric service of a tertiary hospital in Salvador, Bahia, Brazil, and to evaluate the predictors of mortality in this population. Methods: A retrospective cohort was performed, based on the evaluation of the medical records of patients with IE during the period from 2010 to 2016, followed at a tertiary hospital in Salvador. The sample consisted of patients under 18 years of age with the diagnosis of IE. The criteria used for the diagnosis were the Duke criteria, with blood culture and positive echocardiogram as the major criteria, and predisposing heart condition, fever, vascular phenomenon, immunologic phenomenon and microbiological evidence as minor criteria. Data was stored in the registry form and analyzed with the statistical program SPSS 17.0. For the bivariate inferential analysis, the chi square test was used, values of p <0.05 were considered statistically significant. Results: The study group included 31 patients diagnosed with IE, 61.3% male. The mean age was 8.48 ± 6.38 years. All patients had previous heart disease, 74.2% had congenital heart disease and 25.8% had rheumatic heart disease. Previous surgery was present in 45.2% of the patients, and blood culture was positive in 54.8%. A percentage of 38.7% of complications was demonstrated, with embolization corresponding to 22.6% of the cases. There was a statistically significant association between predictor variables: valve prothesis as a site of endocarditis and embolization when associated with death, with proportions of 100% (p = 0.001) and 60% (p = 0.029), respectively. The mortality rate was 16.1%. Discussion: The EI profile in the studied sample still differs from that presented in developed countries, since rheumatic heart disease is still a reality in this population, although it is no longer the greatest risk factor for IE. The epidemiology of the disease is changing, with evolution of risk factors and change of pathogens. EI is still a difficult disease to manage, resulting in high mortality rates. Conclusions: Previous heart disease is the main risk factor for IE, mainly congenital heart disease. Despite this, rheumatic heart disease is still an important risk factor. EI mortality is high, and the main predictors are valve prosthesis as a site of endocarditis and systemic embolization