Pelin KOSGER, Tugcem KESKİN, Hikmet KİZTANİR, Birsen UCAR

I nfektif Endokarditli Çocuklarda Klinik Ö zellikler, Tedavi Yaklaşımları ve Komplikasyonlar: Tu rkiye’den Tek Merkez Deneyimi

Bu çalışma ile 2010-2018 yılları arasında kliniğimizde infektif endokardit tanısı almış hastalar altta yatan risk faktörleri, klinik ve laboratuvar bulguları, tedavi yaklaşımları, antikoagülan tedavi ile ilgili deneyimler ve izlemde ortaya çıkan komplikasyonlar açısından geriye dönük olarak değerlendirildi. İnfektif endokardit tanısı alan 11 hastaya ulaşıldı. Komplikasyon meydana gelen, antibiyoterapiye ilave olarak antikoagülan tedavi uygulanan, cerrahiye verilen ve mortal seyir gösteren hastaların özellikleri saptandı. En küçük hasta 7 aylık, en büyüğü 14 yaşındaydı (7.5 ± 4.6 yıl). Olguların 10’unda infektif endokardit için risk oluşturan konjenital kalp anomalisi mevcut olup, romatizmal kalp hastalığına sahip olgu yoktu. Toplam sekiz olguda embolik bulgular saptandı. Dokuz olguda ekokardiyografide vejetasyon izlendi. İki olguda antibiyoterapiye ilave olarak antikoagülan tedavi uygulandı. Koagülaz negatif stafilakok, beş olgu ile kan kültüründe en sık üreyen mikroorganizma idi. Beş olguya erken cerrahi tedavi uygulandı. Bir olgu sistemik embolizasyona bağlı gelişen çoklu organ yetmezliği, bir olgu ise izleminin birinci haftasında aniden gelişen hemodinamik bozulma nedeniyle öldü. İnfektif endokardit hayatı tehdit eden komplikasyonlar ile seyredebilen ciddi bir hastalıktır. Erişkinlerden farklı olarak, çocuklarda altta yatan başlıca risk faktörü konjenital kalp hastalıklarıdır. Tanı sonrasında, septik embolizasyon ve mortalitenin önlenebilmesi için olabildiğince erken uygun antibiyoterapi başlanmalıdır. Embolizmin önlenmesi ve iskemik inme tedavisinde antikoagülasyonun yeri ise tartışmalı bir konudur.

Anahtar Kelimeler:

Enfektif endokardit, çocuklar, embolizm, antikoagülasyon

Clinical Characteristics, Treatment Approaches, and Complications in Children with Infective Endocarditis: A Single Center Experience From Turkey

In this study, we retrospectively evaluated the underlying risk factors, clinical and laboratory findings, treatment approaches, anticoagulation therapy experiences, and the complications that arose during the follow-up of patients diagnosed with infective endocarditis in our clinic between 2010–2018. Eleven patients with infective endocarditis were evaluated. The relevant features of the patients whom developed complications, given anticoagulant therapy in addition to antibiotherapy, underwent cardiac surgery, and showed a mortality course were determined. The youngest patient was 7 months old and the oldest was 14 years old (7.5 ± 4.6 years). All of the cases had congenital heart anomalies and there were no cases with rheumatic heart disease. A total of eight patients had embolic findings. Echocardiography showed vegetation in nine patients. In addition to antibiotherapy, anticoagulant treatment was applied to 2 patients. The most common microorganism in the blood culture was coagulase negative staphylococci with five cases. Five patients underwent early surgical treatment, one patient died due to multiple organ failure caused by systemic embolization, and one patient died due to sudden hemodynamic instability in the first week of follow-up. Infective endocarditis is a serious disease with life-threatening complications. In children, the main underlying risk factor is congenital heart disease unlike with adults. Once the diagnosis is made, appropriate antibiotherapy should be initiated as soon as possible to prevent septic embolism and mortality. The role of anticoagulation in the prevention of embolism and the treatment of ischemic stroke remains controversial.

Keywords:

İnfective endocarditis, children, embolism, anticoagulation,

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