Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Positive blood culture Intracardiac oscillating mass, abscess, or new valve regurgitation on echocardiogram Fever Elevated erythrocyte sedimentation rate or C-reactive protein +++ General Considerations ++ Bacterial or fungal infection of the endocardium Rare Usually occurs in the setting of a preexisting abnormality of the heart or great arteries May occur in a normal heart during septicemia or as a consequence of infected indwelling central catheters The frequency of infective endocarditis (IE) appears to be increasing for following reasons Increased survival in children with congenital heart disease (CHD) Greater use of central venous catheters Increased use of prosthetic material and valves Children without preexisting heart disease are also at increased risk for IE because of Increased survival rates for children with immune deficiencies Long-term use of indwelling lines in ill newborns and patients with chronic diseases Increased injection drug use Children at greatest risk Those with unrepaired or palliated cyanotic heart disease (especially in the presence of an aorta to pulmonary shunt) Those with implanted prosthetic material Those who have had a prior episode of IE Common causative organisms Viridans streptococci (30–40% of cases) Staphylococcus aureus (25–30%) Fungal agents (about 5%) +++ Clinical Findings ++ Fever, malaise, and weight loss Joint pain and vomiting are less common New or changing murmur Splenomegaly Hepatomegaly +++ Diagnosis ++ Laboratory findings Multiple positive blood cultures Elevated erythrocyte sedimentation rate or C-reactive protein Hematuria Transthoracic echocardiography can identify large vegetations in some patients However, transesophageal imaging has better sensitivity +++ Treatment ++ Appropriate antibiotic therapy should be initiated as soon as IE is suspected Therapy can be tailored once the pathogen and sensitivities are defined Vancomycin or a β-lactam antibiotic, with or without gentamicin, for a 6-week course is most common regimen Surgical excision of the infected area and prosthetic valve replacement must be considered if heart failure occurs and progresses despite adequate antibiotic therapy +++ Outcome +++ Prevention ++ Conditions requiring antibiotic prophylaxis Prosthetic cardiac valves Prior episode of IE CHD Cardiac transplant with valvulopathy IE prophylaxis is not recommended for Gastrointestinal or genitourinary procedures Body piercing Tattooing Recommended prophylaxis 50 mg/kg of oral amoxicillin for patients < 40 kg 2000 mg of oral amoxicillin for those > 40 kg Dose is to be given 1 hour prior to procedure +++ Prognosis ++ Factors associated with a poor outcome Delayed diagnosis Presence of prosthetic material Perioperative associated IE S aureus infection Mortality for bacterial endocarditis in children ranges from 10% to 25%, with fungal infections having a much greater mortality (50% or more) +++ Reference + +Wilson W et al: Prevention of infective endocarditis: guidelines from the American Heart Association: ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth