Clinical characteristics of infective endocarditis in children: a single center of 10-year experience in Beijing

The aim of the study was to present the clinical features and microbiology of pediatric infective endocarditis (IE) in Beijing. We retrospectively evaluated children aged < 18 years diagnosed with IE between 2015 and 2024. A total of 74 patients were enrolled, with a male predominance ( n = 44, 59.5%). The median time from onset to diagnosis was 14.5 (8.0-20.1) days. Predisposing factors were identified in 51 patients (68.9%), with underlying cardiac conditions present in 50 cases (67.6%). Forty-seven patients (63.5%) had complications. Multi-site infections were observed in 29 patients (39.2%), among which bacterial meningitis was the most frequent ( n = 16, 21.6%). Causative pathogens were identified in 58 patients (78.4%), with Staphylococcus aureus ( S. aureus ) being the predominant organism ( n = 34, 45.9%). Compared with other culture-positive bacterial IE, the S. aureus endocarditis (SAE) group exhibited significantly shorter time-to-diagnosis ( p = 0.008), a lower proportion of predisposing factors ( p = 0.039), higher peak temperature ( p = 0.019), higher levels of C-reactive protein ( p = 0.001) and procalcitonin ( p < 0.001), and higher rates of multi-site infections ( p < 0.001), bacterial meningitis ( p = 0.005), embolic events ( p = 0.008), sepsis ( p = 0.006), intensive care unit admission ( p = 0.032), and death ( p = 0.024). The overall mortality rate was 16.2% (12/74). On multivariable analysis, shock [OR 15.294 (95%CI 1.196–95.559), p = 0.036] and cerebral hemorrhage [OR 16.743 (95%CI 1.285–55.191), p = 0.031] were identified as independent predictors of death. IE remains a life-threatening condition with considerable mortality in children. S. aureus is the most frequently identified pathogen in pediatric IE. SAE patients tend to have severe clinical manifestations, high bacterial infection indicators and higher mortality. Shock and cerebral hemorrhage are independent predictors of death, highlighting the need for early recognition and aggressive management of these complications.