Infective endocarditis in children
- Sharon E O'Brien, MD
Sharon E O'Brien, MD
- Assistant Professor of Pediatrics
- Boston University School of Medicine
- Section Editors
- David R Fulton, MD
David R Fulton, MD
- Section Editor — Pediatric Cardiology
- Associate Professor of Pediatrics
- Harvard Medical School
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Infective endocarditis (IE) is an infection of the endocardium and/or heart valves that involves thrombus formation (vegetation), which may damage the endocardial tissue and/or valves. Although uncommon in children, it is important to identify and treat IE because of its significant morbidity and mortality. Prompt diagnosis, rapid treatment, and recognition of complications are imperative for optimal patient outcomes.
IE is also referred to as bacterial endocarditis because bacteria are the predominant microbial pathogens. IE is used in this review to include both bacterial and fungal endocarditis.
Many aspects of IE are similar in children and adults, but there are some manifestations that are unique to children. An overview of IE in children is presented here. A number of other topics address particular issues in detail, some of which will be addressed here for children:
●Antibiotic prophylaxis of IE (see "Antimicrobial prophylaxis for bacterial endocarditis")
●Antimicrobial therapy for IE (see "Antimicrobial therapy of native valve endocarditis" and "Antimicrobial therapy of prosthetic valve endocarditis")
- Ferrieri P, Gewitz MH, Gerber MA, et al. Unique features of infective endocarditis in childhood. Circulation 2002; 105:2115.
- Saiman L, Prince A, Gersony WM. Pediatric infective endocarditis in the modern era. J Pediatr 1993; 122:847.
- Day MD, Gauvreau K, Shulman S, Newburger JW. Characteristics of children hospitalized with infective endocarditis. Circulation 2009; 119:865.
- Marom D, Levy I, Gutwein O, et al. Healthcare-associated versus community-associated infective endocarditis in children. Pediatr Infect Dis J 2011; 30:585.
- Ware AL, Tani LY, Weng HY, et al. Resource utilization and outcomes of infective endocarditis in children. J Pediatr 2014; 165:807.
- García-Teresa MA, Casado-Flores J, Delgado Domínguez MA, et al. Infectious complications of percutaneous central venous catheterization in pediatric patients: a Spanish multicenter study. Intensive Care Med 2007; 33:466.
- Rastogi A, Luken JA, Pildes RS, et al. Endocarditis in neonatal intensive care unit. Pediatr Cardiol 1993; 14:183.
- Rech A, Loss JF, Machado A, Brunetto AL. Infective endocarditis (IE) in children receiving treatment for cancer. Pediatr Blood Cancer 2004; 43:159.
- Daher AH, Berkowitz FE. Infective endocarditis in neonates. Clin Pediatr (Phila) 1995; 34:198.
- Rosenthal LB, Feja KN, Levasseur SM, et al. The changing epidemiology of pediatric endocarditis at a children's hospital over seven decades. Pediatr Cardiol 2010; 31:813.
- Martin JM, Neches WH, Wald ER. Infective endocarditis: 35 years of experience at a children's hospital. Clin Infect Dis 1997; 24:669.
- Pasquali SK, He X, Mohamad Z, et al. Trends in endocarditis hospitalizations at US children's hospitals: impact of the 2007 American Heart Association Antibiotic Prophylaxis Guidelines. Am Heart J 2012; 163:894.
- Johnson DH, Rosenthal A, Nadas AS. A forty-year review of bacterial endocarditis in infancy and childhood. Circulation 1975; 51:581.
- Zakrzewski T, Keith JD. Bacterial endocarditis in infants and children. J Pediatr 1965; 67:1179.
- Van Hare GF, Ben-Shachar G, Liebman J, et al. Infective endocarditis in infants and children during the past 10 years: a decade of change. Am Heart J 1984; 107:1235.
- Rushani D, Kaufman JS, Ionescu-Ittu R, et al. Infective endocarditis in children with congenital heart disease: cumulative incidence and predictors. Circulation 2013; 128:1412.
- Ashkenazi S, Levy O, Blieden L. Trends of childhood infective endocarditis in Israel with emphasis on children under 2 years of Age. Pediatr Cardiol 1997; 18:419.
- Niwa K, Nakazawa M, Tateno S, et al. Infective endocarditis in congenital heart disease: Japanese national collaboration study. Heart 2005; 91:795.
- Dodo H, Child JS. Infective endocarditis in congenital heart disease. Cardiol Clin 1996; 14:383.
- Morris CD, Reller MD, Menashe VD. Thirty-year incidence of infective endocarditis after surgery for congenital heart defect. JAMA 1998; 279:599.
- Johnson JA, Boyce TG, Cetta F, et al. Infective endocarditis in the pediatric patient: a 60-year single-institution review. Mayo Clin Proc 2012; 87:629.
- Milazzo AS Jr, Li JS. Bacterial endocarditis in infants and children. Pediatr Infect Dis J 2001; 20:799.
- Stockheim JA, Chadwick EG, Kessler S, et al. Are the Duke criteria superior to the Beth Israel criteria for the diagnosis of infective endocarditis in children? Clin Infect Dis 1998; 27:1451.
- Millard DD, Shulman ST. The changing spectrum of neonatal endocarditis. Clin Perinatol 1988; 15:587.
- Oelberg DG, Fisher DJ, Gross DM, et al. Endocarditis in high-risk neonates. Pediatrics 1983; 71:392.
- Baltimore RS, Gewitz M, Baddour LM, et al. Infective Endocarditis in Childhood: 2015 Update: A Scientific Statement From the American Heart Association. Circulation 2015; 132:1487.
- Kavey RE, Frank DM, Byrum CJ, et al. Two-dimensional echocardiographic assessment of infective endocarditis in children. Am J Dis Child 1983; 137:851.
- Penk JS, Webb CL, Shulman ST, Anderson EJ. Echocardiography in pediatric infective endocarditis. Pediatr Infect Dis J 2011; 30:1109.
- Coward K, Tucker N, Darville T. Infective endocarditis in Arkansan children from 1990 through 2002. Pediatr Infect Dis J 2003; 22:1048.
- Barbour SI, Louie EK, O'Keefe JP. Penetration of the atrialventricular septum by spread of infection from aortic valve endocarditis: early diagnosis by transesophageal echocardiography and implications for surgical management. Am Heart J 1996; 132:1287.
- Karalis DG, Bansal RC, Hauck AJ, et al. Transesophageal echocardiographic recognition of subaortic complications in aortic valve endocarditis. Clinical and surgical implications. Circulation 1992; 86:353.
- Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.
- Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116:1736.
- Risk factors
- - Preexisting heart disease
- CLINICAL MANIFESTATIONS
- Laboratory tests
- - Blood cultures
- - Echocardiography
- Other tests
- Risk factors for IE complications
- Antibiotic regimens
- - Monitoring
- Surgical intervention
- SUMMARY AND RECOMMENDATIONS