Effect of Congenital Heart Disease Status on Trends in Pediatric Infective Endocarditis Hospitalizations in the United States Between 2000 and 2012
- 80 Downloads
The purpose of this study was to create national estimates for the incidence of pediatric infective endocarditis (IE) in the United States and to determine if these changed after the implementation of the 2007 American Heart Association IE guidelines. It also sought to determine the effect of congenital heart disease (CHD) status on outcomes in IE. Hospital discharges with the diagnosis of IE in patients < 18 years old from the Kids’ Inpatient Database were identified from the years 2000, 2003, 2006, 2009, and 2012. Discharges were grouped into Pre- and Post-2007 groups to facilitate analysis surrounding the implementation of the guidelines in 2007. Patients were categorized by age, underlying CHD, and etiologic organism. Descriptive comparisons and changes in categorical variables were made between groups. Average annual IE hospitalization rates before and after the 2007 guidelines were 10.8 and 9.3 per 1,000,000 children, respectively. The proportion of IE patients with CHD was stable between time periods, (45% vs. 47%, p = 0.50). Mortality was higher in the Post-2007 time period for CHD patients than non-CHD patients (11.1% vs. 2.4%, respectively; p < 0.001), while there was no difference noted during the Pre-2007 time period (6.5% vs. 6.6%, respectively; p = 0.95). Streptococcus was more common among CHD patients than non-CHD patients (27% vs. 17%), while Staphylococcus was more common among non-CHD patients than CHD patients (34% vs. 24%, p < 0.001). Even though the incidence of IE was stable over time, mortality was higher in CHD patients after the implementation of the 2007 AHA IE prophylaxis guidelines.
KeywordsCongenital heart disease Infective endocarditis National trends
No external funding was used for this manuscript.
Compliance with Ethical Standards
Conflict of interest
The authors have no potential conflicts of interest to disclose.
Research Involving Human Rights
This article does not contain any studies with human participants performed by any of the authors.
- 1.Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST, Nouri S, Newburger JW, Hutto C, Pallasch TJ, Gage TW, Levison ME, Peter G, Zuccaro G Jr (1997) Prevention of bacterial endocarditis. Recommendations by the American Heart Association JAMA 277(22):1794–1801CrossRefGoogle Scholar
- 2.Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT, American Heart Association Rheumatic Fever E, Kawasaki Disease C, American Heart Association Council on Cardiovascular Disease in the Y, American Heart Association Council on Clinical C, American Heart Association Council on Cardiovascular Anesthesia S, Quality of C, Outcomes Research Interdisciplinary Working G (2007) Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 116 (15):1736–1754. https://doi.org/10.1161/CIRCULATIONAHA.106.183095 CrossRefPubMedGoogle Scholar
- 3.Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, Hirsch GA, Mehta JL (2015) Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol 65(19):2070–2076. https://doi.org/10.1016/j.jacc.2015.03.518 CrossRefPubMedGoogle Scholar
- 5.Bates KE, Hall M, Shah SS, Hill KD, Pasquali SK (2016) Trends in infective endocarditis hospitalisations at United States children’s hospitals from 2003 to 2014: impact of the 2007 American Heart Association antibiotic prophylaxis guidelines. Cardiol Young. https://doi.org/10.1017/S1047951116001086 CrossRefPubMedGoogle Scholar
- 6.Pasquali SK, He X, Mohamad Z, McCrindle BW, Newburger JW, Li JS, Shah SS (2012) Trends in endocarditis hospitalizations at US children’s hospitals: impact of the 2007 American Heart Association Antibiotic Prophylaxis Guidelines. Am Heart J 163(5):894–899. https://doi.org/10.1016/j.ahj.2012.03.002 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Welke KF, Diggs BS, Karamlou T, Ungerleider RM (2009) Comparison of pediatric cardiac surgical mortality rates from national administrative data to contemporary clinical standards. Ann Thorac Surg 87(1):216–222. https://doi.org/10.1016/j.athoracsur.2008.10.032 discussion 222 – 213.CrossRefPubMedGoogle Scholar
- 11.HCUP Kids’ Inpatient Database (KID). Healthcare Cost and Utilization Project (HCUP): 2000, 2003, 2006, 2009, and 2012 Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/kidoverview.jsp
- 14.Doucette A, Jiang X, Fryzek J, Coalson J, McLaurin K, Ambrose CS (2016) Trends in respiratory syncytial virus and bronchiolitis hospitalization rates in high-risk infants in a United States Nationally Representative Database, 1997–2012. PLoS ONE 11(4):e0152208. https://doi.org/10.1371/journal.pone.0152208 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D (2014) Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 14:199. https://doi.org/10.1186/1471-2431-14-199 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Chu B, Houchens R, Elixhauser A, Ross D. Using the KIDS’ Inpatient Database (KID) to Estimate Trends. HCUP Methods Series Report # 2007-02 Online. January 10, 2007. U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/methods.jsp
- 18.Houchens R, Elixhauser A. Calculating Kids’ Inpatient Database (KID) Variances.. HCUP Methods Series Report # 2005-07 Online. December 16, 2005. U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/methods.jsp
- 19.United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). Bridged-Race Population Estimates, United States. July 1st resident population by state, county, age, sex, bridged-race, and Hispanic origin. Compiled from 1990 to 1999 bridged-race intercensal population estimates (released by NCHS on 7/26/2004); revised bridged-race 2000–2009 intercensal population estimates (released by NCHS on 10/26/2012); and bridged-race Vintage 2015 (2010–2015) postcensal population estimates (released by NCHS on 6/28/2016). Available on CDC WONDER Online Database. http://wonder.cdc.gov/bridged-race-v2015.html Accessed May 1 2017
- 22.Halfhill T, Tom’s Inflation Calculator. http://www.halfhill.com/inflation_js.html. Accessed March 1 2017
- 23.Guideline on Periodicity of Examination, Preventive Dental Services (2016) anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Pediatr Dent 38(6):133–141Google Scholar