ABSTRACT. Purpose. The prevalence of infective endocarditis
(IE) among children with Staphylococcus aureus
bacteremia (SAB) is unknown. The objective of this
study was to determine prospectively the prevalence of
IE among pediatric patients with SAB in a large tertiary
care center.
Methods. Between July 1998 and June 2001, all children
who developed SAB whose parent/guardian signed
informed consent underwent echocardiography. Clinical
and follow-up results were collected prospectively. Endocarditis
was classified according to the modified Duke
criteria.
Results. Fifty-one children developed SAB during
the study interval. Definite (6 patients [11.8%]) or possible
(4 patients [7.8%]) IE was present in 10 of 51 (20%)
children with SAB. Most children (73%) developed bacteremia
as a consequence of an infected intravascular
device. Children with underlying congenital heart disease
had a significantly higher prevalence of definite or
possible IE, compared with those with structurally normal
hearts (53% vs 3%). All patients with definite IE had
multiple positive blood cultures. Mortality was high
among patients with and without IE (40% vs 12%).
Conclusions. In this study, the prevalence of definite
IE among children with SAB was 12% and was frequently
associated with congenital heart disease and
multiple positive blood cultures. The mortality for children
with SAB and definite or possible S aureus IE is high.
Pediatrics 2005;115:e15–e19. URL: www.pediatrics.org/cgi/
doi/10.1542/peds.2004-1152; infective endocarditis, Staphylococcus
aureus, congenital heart disease.