Infective Endocarditis in Pediatric Patients with Congenital Heart Disease: Results from a National Multicenter Study

Abstract: Infective endocarditis (IE) remains a significant cause of morbidity and mortality in pediatric patients with congenital heart disease (CHD), however, data on its epidemiology, risk factors, symptoms, complications, and outcomes remain scarce. This retrospective multicenter study analyzed pediatric patients (< 18 years) with CHD diagnosed with IE between 2008 and 2023. Clinical data—including demographic information, cardiac history, echocardiographic findings, microbiological results, treatment strategies, and outcomes—were collected and analyzed. A total of 41 patients were included. The most common risk factors were prior cardiac surgery or percutaneous intervention, prosthetic materials, and significant valvulopathies. A significant association was observed between vegetation size and embolic events, with larger vegetation conferring a higher embolic risk. Staphylococcus aureus and Coagulase-negative staphylococci were the most frequently isolated microorganisms. Fever, new onset or worsening valvulopathies, and vegetation or abscesses formation were the predominant clinical presentation. Aggressive medical and surgical management resulted in favorable outcome in most patients. While IE remains a major challenge in pediatric CHD patients, early detection and timely intervention are crucial for optimizing outcomes, particularly in patients with large vegetations. Future research should aim to identify additional risk factors and refine strategy for prevention and treatment in this high-risk population.