The recognition and treatment of infective endocarditis

Abstract 

Infective endocarditis is a rare but serious illness in childhood. The majority of infections in childhood occur in children with congenital heart disease and normal heart endocarditis is rare in older children but is being increasingly recognized in preterm neonates undergoing intensive care. The Duke criteria are generally accepted as the most accurate for making a diagnosis of infective endocarditis. The principal infecting organisms are streptococcal species andStaphylococcus aureus . Transthoracic echocardiography is an important tool to clarify diagnosis and to look for the complications of infection. The cornerstone of treatment is a prolonged course of antibiotic treatment with an appropriate bactericidal regimen. Mortality remains high, generally between 10% and 20% in most paediatric series. Those that develop haemodynamic compromise, uncontrolled infection or pose an embolic risk should be assessed for suitability for surgical treatment. The reported results of surgical intervention are generally good. Prevention of recurrent infection is important.

Keywords: infective endocarditis, child, congenital heart disease, echocardiography, cardiac surgery

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• f1 Correspondence to: RPM. Tel.: +44 (0)117 342 8855; Fax: +44 (0)117 342 8857; E-mail: rob.martin@ubht.swest.nhs.uk