infective%20endocarditis%20(pediatric)
INFECTIVE ENDOCARDITIS (PEDIATRIC)
Infective endocarditis is an infection of the endocardial surface of the heart including infections of the large thoracic vessels and intracardiac foreign bodies characterized by the presence of vegetation which is a nidus for microorganism invasion.
Native valve endocarditis is an endovascular microbial infection of native heart valves that may be local including valvular and perivalvular destruction or distal due to detachment of septic vegetations with embolism, metastatic infection and septicemia.
Prosthetic valve endocarditis is an endovascular microbial infection of prosthetic heart valves and may be classified as an infection likely to have been acquired perioperatively and thus being nosocomial or likely to have been community-acquired.

Infective%20endocarditis%20(pediatric) Management

Prevention

  • Antibiotic prophylaxis for the 1st 6 months post-dental procedure is recommended
    • Mainly targets oral Streptococci growth
  • Recommended regimens 30-60 minutes prior to dental procedure:
    • Amoxicillin or Ampicillin 50 mg/kg PO/IV single dose
    • Clindamycin 20 mg/kg PO/IV single dose (for those with Penicillin/Ampicillin allergy)
  • Antibiotic prophylaxis should be started immediately prior to cardiac surgery

Recommendations for antibiotic prophylaxis: (adapted from the 2015 European Society of Cardiology guidelines for the prevention, diagnosis & treatment of infective endocarditis)

  • Patients at highest risk for infective endocarditis:
    • Patients with a prosthetic valve/material post-cardiac valve repair
    • Patients with previous infective endocarditis
    • Patients with congenital heart disease
      • Cyanotic congenital heart disease, without surgical repair, or with residual defects, palliative shunts or conduits
      • Congenital heart disease with complete repair with prosthetic material whether placed by surgery or by percutaneous technique >6 months post-op
      • Post-operative residual defect at the prosthesis implantation site (after cardiac surgery or percutaneous technique)
  • Dental procedures requiring gingival or periapical teeth region manipulation or any procedures involving oral mucosa perforation
  • Not recommended for the following procedures:
    • Dental procedures with local anesthetic application in non-infected tissue, suture removal, braces/orthodontic appliance manipulation, dental X-rays, deciduous teeth eruption, mouth trauma
    • Respiratory tract procedures (eg bronchoscopy, laryngoscopy, endotracheal intubation)
    • Gastrointestinal procedures (eg gastroscopy, colonoscopy, cystoscopy, transesophageal echocardiography)
    • Any dermatological or musculoskeletal procedures

Follow Up

  • Daily exam including temperature & periodic blood tests to monitor for signs of infection
    • Temperature should normalize within 5-10 days with uncomplicated infective endocarditis
  • Continue to monitor for cardiac murmurs, blood pressure, signs of heart failure & embolism in the central nervous system, lungs, spleen & skin
  • Secondary infections in joint & spine may occur
  • C-reactive protein (CRP) decreases rapidly during 1st or 2nd weeks of therapy but may stay slightly elevated for 4-6 weeks or longer
    • Persistently high C-reactive protein typically means an inadequately controlled infection
  • Normalization of white blood cell should also occur within 1-2 weeks
    • Persistently elevated white blood cell indicates active infection
  • Monitor renal function
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