TOPLINE

Among children with infective endocarditis, prosthetic valve infections occurred at an older age and were harder to detect on echocardiography than native valve infections; complications were frequent, and more than half of patients required surgery.

METHODOLOGY

• Researchers retrospectively reviewed clinical records from a specialised paediatric cardiac centre in Italy to examine the clinical course, predictors of severe disease and outcomes, and differences between native and prosthetic valve infections in children younger than 18 years.
• A total of 95 consecutive paediatric patients (median age at diagnosis, 14 years; 62.2% boys) who met the modified Duke criteria for definite or possible infective endocarditis between 2013 and 2024 were included; patients were categorised as those with native valve endocarditis (NVE; n = 30) or prosthetic valve endocarditis (PVE; n = 65) according to the presence and type of prosthetic cardiac material.
• Outcomes assessed were cardiac surgery, paediatric cardiac ICU admission, death, and infective endocarditis recurrence.
• Complicated infective endocarditis was defined as the presence of heart failure; thromboembolic events (systemic or pulmonary); organ injury including kidney injury or neurologic deficit; or any local valvular, perivalvular, or periprosthetic complication.

TAKEAWAY

• Patients with PVE were significantly older than those with NVE (median age at diagnosis, 15.7 vs 7.8 years; P = .00002). Congenital heart disease was present in 88.4% of the overall cohort, and pulmonary valve involvement was significantly more common in PVE than in NVE (64.4% vs 23.3%; P = .0002).
• Staphylococcus aureus was the most frequent pathogen in NVE (30.4% of positive cultures), and viridans streptococci predominated in PVE (31.1% of positive cultures). Coagulase-negative staphylococci were identified exclusively in PVE (23.4% vs 0.0% in NVE; P = .01), although the overall pathogen distribution did not differ significantly between the two groups.
• Echocardiography identified lesions suspicious for endocarditis less frequently in PVE than in NVE (67.7% vs 93.3%; P = .007), leading to a greater use of cardiac CT (55.4% vs 26.7%; P = .01) and metabolic imaging (35.4% vs 13.3%; P = .03) in PVE. Leaflet perforation was more common in NVE than in PVE (30.0% vs 1.5%; P = .00002).
• Complicated infective endocarditis occurred in 73.7% of patients. Surgery was required in 54.7%, primarily for heart failure (48%), uncontrolled infection (27%), or thromboembolism (25%); in-hospital mortality was 5.3%. Six patients experienced a subsequent episode of endocarditis during follow-up, but only one had recurrence with the same pathogen within 12 months.

IN PRACTICE

"The presence of IE [infective endocarditis] involving prosthetic material dictates a specialized diagnostic approach utilizing multimodality imaging, including CTA [CT angiography] and metabolic studies (PET/SPECT [single-photon emission CT]), to reliably confirm infection in cases where echocardiography sensitivity is compromised, or when additional information is required, as well as a multidisciplinary team management mandated by modern ESC [European Society of Cardiology] guidelines," the authors of the study wrote.

SOURCE

This study was led by R. Iacobelli, Pediatric Cardiology, Clinical Area of Fetal and Cardiovascular Sciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. It was published online on September 02, 2026, in the European Journal of Pediatrics.

LIMITATIONS

The retrospective study design may have introduced documentation and selection biases. Blood cultures were negative in 28.4% of patients, possibly reflecting referral after antimicrobial therapy initiation. The single-centre setting limited the generalisability of the findings to broader populations.

DISCLOSURES

This study was supported by the Italian Ministry of Health through "Current Research Funds." The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.