Pediatric infective endocarditis carries substantial morbidity particularly in children with congenital heart disease and prosthetic material, with valve-specific clinical patterns showing distinct age distribution, microbiology, and imaging sensitivity between native and prosthetic valve endocarditis.
Key Findings
Results
Congenital heart disease was the predominant predisposing factor for pediatric infective endocarditis, present in 88.4% of the cohort.
95 patients were identified for analysis from 2013 to 2024 at a specialized cardiac center.
62.2% of patients were male, with a median age of 14 years [IQR 7-17].
Diagnosis was made using modified Duke criteria.
The right ventricle-pulmonary artery (RV-PA) conduit was the most commonly affected structure in prosthetic valve endocarditis (PVE), accounting for 47.7% of PVE cases.
Results
Native valve endocarditis (NVE) patients were significantly younger than prosthetic valve endocarditis (PVE) patients.
Median age for NVE patients was 7.8 years compared to 15.7 years for PVE patients.
The difference was statistically significant (p < 0.0002).
This age difference reflects the impact of improved survival among CHD patients who subsequently undergo prosthetic valve implantation as they grow older.
Results
Staphylococcus aureus was the predominant pathogen in NVE while Viridans Streptococci predominated in PVE, and Coagulase-negative Staphylococci (CoNS) were exclusively found in the PVE group.
Staphylococcus aureus accounted for 30.4% of NVE cases.
Viridans Streptococci were more frequent in PVE, accounting for 31.1% of cases.
CoNS were found in 23.4% of positive cultures in PVE versus 0% in NVE (p = 0.01).
The exclusive presence of CoNS in PVE highlights a distinct microbiological profile for prosthetic valve infections.
Results
Echocardiography identified lesions suspicious for endocarditis significantly less frequently in PVE compared to NVE, necessitating greater use of advanced imaging modalities.
Echocardiography identified suspicious lesions in 67.7% of PVE cases versus 93.3% of NVE cases (p = 0.007).
The lower echocardiographic sensitivity in PVE was associated with significantly higher utilization of Cardiac Computed Tomography (p = 0.01).
Metabolic imaging use was also significantly higher in PVE cases (p = 0.03).
These findings underscore the diagnostic challenges posed by prosthetic material obscuring echocardiographic views.
Results
Surgical intervention was required in more than half of all pediatric IE cases, with heart failure being the most common indication.
54.7% of the 95 patients required surgical intervention.
Heart failure (HF) was the primary indication for surgery, accounting for 48.1% of surgical cases.
Other indications for surgery included embolic events and uncontrolled infection.
In-hospital mortality was 5.3% across the entire cohort.
What This Means
This research suggests that infective endocarditis (IE) — a serious infection of the inner lining of the heart — remains a significant threat to children and teenagers, especially those born with heart defects (congenital heart disease). Studying 95 pediatric patients treated at a specialized cardiac center over roughly a decade, researchers found that congenital heart disease was the underlying condition in nearly 9 out of 10 cases. Children with prosthetic (artificial) heart valves tended to be older teenagers, while those with infections on their natural valves tended to be younger children around age 8. The type of bacteria causing the infection also differed depending on valve type, and a particular group of bacteria called Coagulase-negative Staphylococci was found only in patients with prosthetic valves.
One of the most clinically important findings was that standard heart ultrasound (echocardiography) was much less reliable at detecting signs of infection in patients with prosthetic valves compared to natural valves — identifying the problem in only about 68% of prosthetic cases versus 93% of natural valve cases. This meant that doctors needed to use more advanced imaging techniques like cardiac CT scans and metabolic imaging significantly more often for prosthetic valve patients. Despite treatment, more than half of all patients needed surgery, most commonly because of heart failure, and the in-hospital death rate was about 5%.
This research suggests that children with congenital heart disease who have had prosthetic valves or conduits implanted represent a particularly challenging and high-risk group for endocarditis. The findings highlight that a 'one-size-fits-all' approach to diagnosis and treatment is insufficient — clinicians need to tailor their strategies based on whether a child has a natural or prosthetic valve, use advanced imaging more readily in prosthetic valve cases, and remain alert to the distinct bacterial patterns in each group to improve outcomes.
Iacobelli R, Ragni L, Samperi S, De Luca M, Mercadante S, Bruno P, et al.. (2026). Infective endocarditis in the pediatric population: A single-center retrospective study of outcomes and predictors.. European journal of pediatrics. https://doi.org/10.1007/s00431-026-07382-8