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

Yıl 2020, Cilt: 42 Sayı: 2, 231 - 239, 17.03.2020

Pelin Kosger Tugcem Keskin Hikmet Kiztanir Birsen Ucar

https://doi.org/10.20515/otd.569875

Cited By: 1

Öz

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

Öz

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.

Anahtar Kelimeler

İnfective endocarditis, children, embolism, anticoagulation

Kaynakça

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