Infective Endocarditis In Children

Infective endocarditis is microbial infection of the endocardial surface, usually involving a heart valve or abnormal intracardiac structure.

Paediatric risk factors include congenital heart disease, prosthetic material, previous endocarditis and central venous catheters.

Staphylococcus aureus, viridans streptococci and other organisms account for many cases.

Presentation may be acute or indolent.

Common features include:

• Persistent fever
• Malaise
• Fatigue
• Weight loss
• New or changing murmur
• Splenomegaly
• Petechiae

Complications include:

• Heart failure
• Systemic embolization
• Stroke
• Pulmonary emboli in right sided infection
• Glomerulonephritis
• Perivalvular abscess

Obtain multiple blood culture sets before antibiotics whenever the child is stable enough for this not to delay emergency treatment.

Investigations include:

• FBC
• CRP and ESR
• Renal function
• Urinalysis
• Echocardiography

Transthoracic echocardiography is usually first line in children. Transoesophageal echocardiography is considered when transthoracic imaging is inadequate or suspicion remains high.

Diagnosis integrates microbiological, echocardiographic and clinical criteria.

Treatment requires prolonged IV bactericidal antibiotics, usually 4 to 6 weeks, tailored to the isolated organism and susceptibility pattern.

Empirical therapy depends on whether infection involves a native valve, prosthetic material, healthcare exposure and local resistance patterns.

Obtain cultures before antibiotics whenever clinically safe, then start empirical therapy promptly in an unwell child.

Persistent bacteraemia, heart failure, abscess formation, fungal infection, prosthetic infection or major embolic risk requires early cardiology, infectious disease and cardiothoracic surgical involvement.

Children at highest risk of adverse outcomes from endocarditis may require antibiotic prophylaxis before selected high risk dental procedures, according to current cardiology guidance.