Infective Endocarditis in Childhood: AHA Scientific Statement
- Baltimore RS, Gewitz M, Baddour LM, et al., on behalf of the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young and the Council on Cardiovascular and Stroke Nursing.
- Infective Endocarditis in Childhood: 2015 Update: A Scientific Statement From the American Heart Association. Circulation 2015;132:1487-1515.
The following are 10 key points to remember regarding an updated American Heart Association Scientific Statement on infective endocarditis (IE) in childhood:
- The annual incidence rate of endocarditis in the United States was between 0.05 and 0.12 cases per 1,000 pediatric admissions from 2003 to 2010, without significant trends.
- IE develops without structural heart disease or other readily identifiable risk factors in 8-10% of pediatric cases.
- In 2008 in the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) guidelines concluded that the use of antibiotic prophylaxis prior to any invasive procedure should cease, unless requested by the patient. A subanalysis of data from a large nationwide study in England showed no change in incidence of IE after implementation of the new recommendations.
- It is reasonable to shift focus from antibiotic prophylaxis prior to procedures to an emphasis on oral hygiene and the prevention of oral disease.
- Blood cultures should be drawn for patients with fever of unexplained origin and a pathological heart murmur, a history of heart disease, or previous endocarditis. It is reasonable to obtain three blood cultures by separate venipunctures on the first day, and if there is no growth by the second day of incubation, to obtain two or three additional cultures.
- The prevalence of culture-negative endocarditis approximates 5% of IE cases in adults and children.
- Testing for antimicrobial susceptibility with determination of the minimum inhibitory concentration (MIC) is recommended for determining the optimal therapy for IE.
- Transthoracic echocardiogram is generally sufficient for identifying the cardiac manifestations of IE in children, particularly for those <60 kg. Transesophageal echocardiogram is indicated for children with abnormalities of the chest wall or thoracic cage, and in those at high risk for aortic root abscesses.
- Valve replacement surgery may be considered and is preferable in most if not all patients with prosthetic valve infection caused by Staphylococcus aureus.
- In general, for patients with IE, the degree of illness should not be considered a limitation to surgical intervention because the alternative, to delay or defer surgery, may be associated with poor outcomes.
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