Predictors of definite and possible infective endocarditis in children with bacteremia: a reginal cohort study.

Infective endocarditis was classified as definite in 0.5% and possible in 40.1% of pediatric bacteremia episodes that underwent echocardiography.

• Among 2810 total bacteremia episodes over 8 years, echocardiography was performed in 573 (20%), with 569 analyzed.
• Definite IE was identified in 3/569 (0.5%) episodes.
• Possible IE was identified in 228/569 (40.1%) episodes.
• IE was rejected in 338/569 (59.4%) episodes.
• Classification used modified Duke criteria.

Only 3% of definite/possible IE cases had diagnostic echocardiographic findings, indicating limited echocardiographic yield.

• Only 7/231 (3.0%) definite/possible IE cases had diagnostic echocardiographic findings.
• Echocardiography was performed in 573 of 2810 total bacteremia episodes (20%).
• This finding supports a selective rather than universal echocardiography approach in pediatric bacteremia.

High-risk cardiac anomalies were independent predictors of infective endocarditis in children with bacteremia.

• High-risk cardiac anomalies included prosthetic valve or material and cyanotic heart disease.
• These were identified as independent predictors in multivariate analysis.
• Antimicrobial resistance, central venous catheters, and prior IE were not associated with increased risk of IE.

Staphylococcus aureus bacteremia and prolonged bacteremia were independent predictors of definite/possible infective endocarditis.

• Both S. aureus bacteremia and prolonged (persistent) bacteremia were identified as independent predictors of IE.
• These factors remained significant in multivariate analysis.
• Central venous catheters and antimicrobial resistance were not independently associated with IE.

Embolic or immunologic phenomena were independent predictors of infective endocarditis in children with bacteremia.

• Embolic or immunologic phenomena were identified as independent predictors of IE alongside cardiac anomalies and bacteremia characteristics.
• Physical examination findings including murmurs did not differentiate IE from non-IE episodes.
• This finding suggests clinical signs alone are insufficient to guide echocardiography decisions.

The study was an 8-year prospective surveillance cohort of all children hospitalized with true bacteremia at a single center.

• The study included all children aged 0–18 years hospitalized at Soroka University Medical Center between 2015 and 2022.
• A bacteremia episode was defined as the growth of a single organism during hospitalization.
• A total of 2810 bacteremia episodes were included in the overall cohort.
• Only episodes in which echocardiography was performed were included in the IE comparison analysis.