口服抗生素降压治疗儿童感染性心内膜炎：单中心回顾性研究

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2025-09-01 DOI:10.1016/j.acvd.2025.06.022

Pauline Remyon , Thibault Tromeur , Pauline Gras , François Godart , Pierre Mauran , Sylvie Falcon-Eicher , Gallet Jean , Dorothée Ardourel , Gilles Bosser , Anne-Sophie Leborgne-Meyer , Tristan Hazelzet , Elise Barre , Sabine Dirani , Annabel Sudaka , Bertrand Stos , Helene Ansquer , Berangere Urbina-Hiel , Emre Belli , Sebastien Hascoet

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引用次数: 0

摘要

儿童感染性心内膜炎（IE）主要影响先天性心脏病患儿，通常涉及假体材料。标准治疗包括4-6周静脉注射抗生素，需要长期住院治疗。虽然成人数据（例如POET试验）支持部分口服治疗，但儿科研究仍然有限，指南也过时了。法国的做法各不相同。方法：我们进行了一项回顾性观察性单中心研究，纳入了2019年1月至2024年6月期间诊断为明确或可能患有IE （Duke标准）的18岁以下患者。患者接受全静脉治疗或静脉注射后口服降压抗生素治疗。结果本组病例共28例，男性占64%，中位年龄11岁（IQR: 5.9 ~ 16.1）。93%的人患有先天性心脏病，67%的人使用了假肢材料。右侧感染性心内膜炎14例，左侧感染性心内膜炎8例，Blalock分流术1例，室间隔补片2例，房间隔缺损封堵器1例。79%的患者接受了手术。15例患者（54%）采用口服降压治疗。其中11例预后良好，2例复发或重新出现IE， 2例缺乏预后资料。17名患者在家中完成了部分治疗：9名患者接受口服抗生素治疗，4名患者接受门诊肠外抗生素治疗，4名患者两者都接受。家庭治疗的平均持续时间为17天，占平均总治疗时间（54天）的三分之一。3例患者出现不良结果（复发或新发IE），其中2例为口服治疗组，但未发生死亡。未见与口服治疗相关的不良事件报告。结论在选定的儿童IE病例中，口服降压抗生素治疗安全有效，可早期出院并改善舒适度。这些发现支持国家对儿童IE管理标准化的建议，并考虑将口服治疗作为一种可行的选择。

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Oral Antibiotic Step-Down Therapy for Pediatric Infective Endocarditis: A Single-Center retrospective Experience

Introduction

Pediatric infective endocarditis (IE) primarily affects children with congenital heart disease, often involving prosthetic material. Standard treatment consists of 4–6 weeks of intravenous (IV) antibiotics, requiring prolonged hospitalization. While adult data (e.g., POET trial) support partial oral therapy, pediatric studies remain limited, and guidelines are outdated. Practices vary widely in France.

Method

We conducted a retrospective observational single-center study including patients under 18 years diagnosed with definite or probable IE (Duke criteria) between January 2019 and June 2024. Patients were treated with either full IV therapy or IV followed by oral step-down antibiotics.

Results

Twenty-eight cases were analyzed (64% male), with a median age of 11 years (IQR: 5.9–16.1). Ninety-three percent had congenital heart disease and 67% had prosthetic material. There were 14 cases of right-sided infective endocarditis, 8 cases of left-sided infective endocarditis, 1 IE on Blalock shunt, 2 cases on a ventricular septal patch, and 1 on a atrial septal defect occluder. Seventy-nine percent of the patients underwent surgery. Oral step-down therapy was used in 15 patients (54%). Among them, 11 had favorable outcomes, 2 had relapses or a new IE, and 2 lacked outcome data. Seventeen patients completed part of their treatment at home: 9 with oral antibiotics, 4 with outpatient parenteral antibiotic therapy, and 4 with both. The mean duration of home treatment was 17 days, accounting for one-third of the average total treatment length (54 days). Three patients experienced unfavorable outcomes (relapse or new IE)—two in the oral therapy group—but no death occurred. No adverse events related to oral therapy were reported.

Conclusion

In selected pediatric IE cases, oral step-down antibiotic therapy appears safe and effective, enabling early discharge and improved comfort. These findings support the development of national recommendations to standardize pediatric IE management and consider oral therapy as a viable option.

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.