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Infective Endocarditis
Infective Endocarditis
Infection of the endothelial surface of the heart. Suspect infective endocarditis in all children with persistent fever and underlying heart disease.
Diagnostic Criteria
Clinical
- Underlying heart defect and a persistent low grade fever without an obvious underlying cause.
- Associated other findings include: fatigue, joint pain, new murmurs, clubbing, splenomegaly and haematuria.
- Must be differentiated from acute carditis due to rheumatic fever.
Modified Duke Criteria for diagnosis of Infective Endocarditis
| MAJOR CRITERIA | MINOR CRITERIA |
| A. Positive blood cultures, specific organisms as per criteria B. Evidence of endocardial involvement | a. Predisposing heart condition or IV drug use b. Fever ≥ 38ºC c. Vascular phenomena d. Immunologic phenomenae. Microbiologic evidence not major criteria |
Investigations
- Blood cultures: Three blood cultures (venous) from different sites within 2 hours if very ill, otherwise over 24 hours. Sterile blood culture technique is essential
- Urine test strips - haematuria
- CRP/ESR may be helpful
- CXR / ECG
- Echo
Management
- Bed rest/limit physical activity
- Ensure adequate nutrition
- Maintain haemoglobin > 10 g/dL
- Measures to reduce fever
- Treat heart failure
- Refer all suspected and confirmed cases
Prophylaxis
For children with an underlying cardiac lesion undergoing procedures that may induce bacteraemia, see local guidelines in doctor’s office.
Antibiotic therapy
- Empiric treatment is started until cultures available. Antibiotics are always given IV, according to culture and sensitivity.
- Empiric treatment:
- Pen G IV, 50 000 units/kg/dose, 6 hourly for 4 weeks,
- PLUS Cloxacillin IV 25 mg/kg/dose 6 hourly for 4 weeks,
- PLUS Gentamicin IV 1,5 mg/kg/dose 8 hourly for 4 weeks
- Once culture available: treat according to sensitivities.