Andersons pediatric cardiology 1482

endocarditis;broadrangebacterial16SrDNAandfungal18SrDNAPCR;
earlysurgery;infectiveendocarditisprophylaxisdowngrade;endocarditis
team
Infectiveendocarditis(IE)isaninfectionoftheendocardium,valves,orrelated
structuresoftheheartandwalls.Itmayarisefollowingmorefrequentand
prolongedbacteremiainapatientwithorwithoutapredisposingcardiaclesion.
Infectiveendarteritisisasimilarprocess.Itmayinvolvepatentductusarteriosus,
shunts(nativeandconstructed),aneurysms,stretchingdevices(stents),collateral
closingdevices,neonatalumbilicallines,anddamagedarterialwalls.Theterm
infectiveendarteritisisnowavoided,andalloftheseareunitedunderIE.
Despiteadvancesindiagnosisandtreatment,IEofthe21stcenturymaystill
bealife-threateningdiseasewithsignificantmortalityandmorbidity.Pediatric
IEhasalowerincidenceandbetteroutcomesthanIEinadults.Thepredisposing
factorsforIEinhigh-incomecountrieshavechanged:althoughrheumaticheart
disease–relatedIEhasdramaticallydeclined,thereisariseofthecongenital
heartdisease(CHD)-related,postprocedural,anddevice-relatedpediatricIE.The
mainstayofmanagementofIEisthemultidisciplinaryapproachcoordinatedby
theendocarditisteam:cardiologist,clinicalmicrobiologist/infectiousdiseases
specialist,andcardiothoracicsurgeon.
Allinformationisoutlinedindetailintheguidelines,recommendations,
reviews,andupdates.1–15


IncidenceofPediatricInfective
Endocarditis
TheIEincidenceinchildrenislowerthaninadultsandreportedstableat
approximately0.43per100,000children/year,16whichisfarbelowthosein
adults,whohaveanincidenceofapproximately3to12per100,000
people/year.14,17,18ANewZealandstudyshowedincreasedincidenceof
pediatricIEfrom0.46per100,000/yearin1994–2002to0.76per100,000/year
in2003–2012.19

CHD-relatedpediatricIEisapproximately60%19to68%20ofthecases.A
largepopulation-based1988–2010studyonalargecohortofCanadianchildren
withCHDreportedanIEincidenceof4.1cases/10,000person-years,21whichis
muchlowerthanthatinadultswithCHDof10.6cases/10,000person-years.22
However,amorerecentstudyfromTaiwansimilarlyreported11.13
cases/10,000person-years.23
ThecumulativeobservedriskofIEis6.1cases/1000CHDpatients0to18
yearsofage.21
CyanoticCHDlesions,left-sidedlesions,andatrioventricularseptaldefects
wereassociatedwithincreasedriskofIEacquisitioninchildhood.Therelative
riskofdevelopingIEwassubstantiallyelevatedduringthe6-month
postoperativeperiodofcardiacsurgeryandinchildrenyoungerthan3yearsof
age.21
ThereisacomparableIEfrequencyinboysandgirlsbecausehigh-risk
behaviorsandotherlifestylefactorsmaybelesslikelytodifferbetweenboys
andgirlsduringchildhood.21,24


MortalityRisk
Despitesignificantimprovements,pediatricIEremainsadiseasewithsignificant
mortalityrisk,varyingfrom5%24,19to10%25butismuchlowerthanintheadult
IE,whichisstillreportedatapproximately25%.
PediatricIE–relatedmortalityismuchlowerinnativevalveendocarditis3.5%
thaninpatientswithunderlyingheartdisease6.7%.Riskfactorsformortality
includesomeformsofCHD,premature/neonatalage,fungus,and
Staphylococcusaureusasetiologicagents.24