Andersons pediatric cardiology 1483
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CostofManagement
ThepriceofpediatricIEhospitalmanagementishigh;intheUnitedStates,it
variesbetween$131,000and$140,655.26
Epidemiology
ThechangingepidemiologyanduniquefeaturesofpediatricIEhavebeenwell
outlined.6,24,27–29Beforethe1970s,upto50%ofthepediatricIEwasrheumatic
heartdisease–relatedIE.Afterthe1970s,inhigh-incomecountries,therehas
beenagradualdecreaseandalmostcompletedisappearanceofrheumaticheart
disease–relatedpediatricIEbutwithaconcomitantriseofCHD-relatedIE;the
riseofdegenerativevalvulopathiesandintravenousdrugabuse–relatedIEin
adultsisnotseeninchildren.PediatricIEchangesarealsomarkedbytheriseof
S.aureusasacausativeagent,aswellasdevice-relatedIEandpostprocedural
IE.Multiplesite(dualvalve)IEisbeingseenmoreoften.Thechanging
epidemiologyissummarizedinBox56.1.
Box56.1
ChangingProfileofInfectiveEndocarditisin
High-IncomeCountries
1.Changingunderlyingpredisposingfactor:
■↓Acquiredrheumaticheartdiseaserelated
■↑Congenitalheartdiseaserelated
■↑Device/prosthesisrelated
■↑Degenerativevalvediseaserelatedinelderly
■↑Intravenousdrugabuserelatedinadults
■↑Previousinfectiveendocarditis(recurrence,reinfection)
2.Changingmicrobiology:
■↑Staphylococcal
■↓Streptococcal
■↑Blood-culturepositive(>70%)(improveddiagnosis:techniques,
fastidiousorganisms)
■↑Intracellularorganisms(improveddiagnosis:sensitiveserology,
PCRfromvegetations)
3.Changingwayofacquisition:
■↓Communityacquired
■↑Healthcareassociated
4.Changinglocalizationoflesions:
■↑Multiplesite(neighboringandnonneighboring)
■↑Rightsided
■↑Recurrent
PCR,Polymerasechainreaction.
