Pediatric Infective Endocarditis: A 23-Year Experience from a Tertiary Care Center in Türkiye

Background/Objectives: Infective endocarditis (IE) is a rare but life-threatening infection in children, most often associated with congenital heart disease. This study aimed to evaluate the clinical characteristics, microbiological and echocardiographic findings, management strategies, outcomes, and factors associated with mortality in pediatric IE over a 23-year period at a tertiary care center. Methods: We retrospectively reviewed patients aged 0–18 years diagnosed with definite IE according to the modified Duke criteria between January 2000 and December 2022. Demographic, clinical, microbiological, echocardiographic, therapeutic, and outcome data were analyzed. Results: Seventeen patients were identified (mean age: 9.0 ± 5.9 years; 58.8% male). Congenital heart disease was present in 82%, and 47% had undergone prior cardiac surgery. Blood cultures were positive in 58.8%, with Staphylococcus aureus and Staphylococcus epidermidis being the most frequently identified pathogens. Echocardiography revealed vegetations in 88% of cases. Surgical intervention was performed in 70.5% of patients. Extracardiac complications occurred in 70.5%, most commonly acute kidney injury (35%) and thromboembolic events (23%). Three patients (17.6%) died; younger age and lower body weight were significantly associated with mortality. Conclusions: Pediatric IE continues to carry substantial morbidity and mortality. Younger age and lower body weight were associated with mortality in our cohort; however, the association with lower body weight may be confounded by age. Early recognition and multidisciplinary management, including timely surgical intervention when indicated, remain essential for improving outcomes.