Thông tin tài liệu
Cost of Management The price of pediatric IE hospital management is high; in the United States, it varies between $131,000 and $140,655.26 Epidemiology The changing epidemiology and unique features of pediatric IE have been well outlined.6,24,27–29 Before the 1970s, up to 50% of the pediatric IE was rheumatic heart disease–related IE After the 1970s, in high-income countries, there has been a gradual decrease and almost complete disappearance of rheumatic heart disease–related pediatric IE but with a concomitant rise of CHD-related IE; the rise of degenerative valvulopathies and intravenous drug abuse–related IE in adults is not seen in children Pediatric IE changes are also marked by the rise of S aureus as a causative agent, as well as device-related IE and postprocedural IE Multiple site (dual valve) IE is being seen more often The changing epidemiology is summarized in Box 56.1 Box 56.1 Changing Profile of Infective Endocarditis in High-Income Countries Changing underlying predisposing factor: ■ ↓ Acquired rheumatic heart disease related ■ ↑ Congenital heart disease related ■ ↑ Device/prosthesis related ■ ↑ Degenerative valve disease related in elderly ■ ↑ Intravenous drug abuse related in adults ■ ↑ Previous infective endocarditis (recurrence, reinfection) Changing microbiology: ■ ↑ Staphylococcal ■ ↓ Streptococcal ■ ↑ Blood-culture positive (>70%) (improved diagnosis: techniques, fastidious organisms) ■ ↑ Intracellular organisms (improved diagnosis: sensitive serology, PCR from vegetations) Changing way of acquisition: ■ ↓ Community acquired ■ ↑ Health care associated Changing localization of lesions: ■ ↑ Multiple site (neighboring and nonneighboring) ■ ↑ Right sided ■ ↑ Recurrent PCR, Polymerase chain reaction ...Epidemiology The changing epidemiology and unique features of pediatric IE have been well outlined.6,24,27–29 Before the 1970s, up to 50% of the pediatric IE was rheumatic heart disease–related IE After the 1970s, in high-income countries, there has... disease–related pediatric IE but with a concomitant rise of CHD-related IE; the rise of degenerative valvulopathies and intravenous drug abuse–related IE in adults is not seen in children Pediatric IE changes are also marked by the rise of
Ngày đăng: 22/10/2022, 12:55
Xem thêm:
