Infective Endocarditis in Neonates at Charlotte Maxeke Johannesburg Academic Hospital: A Retrospective Study (January 2015-March 2021)

Abstract

BACKGROUND Paediatric endocarditis is rare but has significant morbidity and mortality. Neonatal endocarditis is an area lacking research. Previously endocarditis was associated with congenital cardiac lesions but with advancing medical care children with structurally normal hearts are developing endocarditis. The diagnosis is made using the Modified Duke Criteria and requires a high level of suspicion in neonates. METHODS Clinical and microbiological data was collected from a tertiary hospital in Johannesburg from 01 January 2015 to 31 March 2021. Data analysis included using the Modified Duke Criteria to determine if the patient had definite or probable endocarditis and these data were included. RESULTS There were 38 cases of probable endocarditis and four definite endocarditis, this accounts for 0.98% of the paediatric patients that were referred for echo during the study period. Two cases were community-acquired endocarditis. One patient had a cyanotic cardiac lesion, and seven patients had acyanotic cardiac lesions. The predominant causative organism was gram-negative bacteria (38.1%) followed by fungal (28.6%), 23.8% cases were due to gram-positive organisms and 21.4% were culture negative cases. A 42-day course of antibiotics was completed in 11 patients prior to the outcome. Another 40% of the patients were on directed antibiotics at outcome. The all-cause case fatality rate was 42.9%. CONCLUSION Endocarditis is an important condition in paediatrics due to advancements in medical care. Gram- negative bacteria and fungal pathogens are important organisms in hospital acquired endocarditis. Data relating to neonatal endocarditis is lacking and this research suggests that the condition may be more common than currently thought to be. A high index of suspicion is required in septic neonates and a multidisciplinary approach to the management of these neonates is imperative.