Infective Endocarditis in Childhood: 2015 Update: A Scientific Statement From the American Heart Association.

Abstract

In 2002, the American Heart Association (AHA) published “Unique Features of Infective Endocarditis in Childhood,”1 which reviewed epidemiology, pathogenesis, diagnosis, clinical and laboratory findings, treatment, and prevention of infective endocarditis (IE) with particular attention to children. Since that time, other AHA reports have focused on new recommendations for treatment of IE in adults (in 20052) and on major changes regarding prevention of IE (in 20073). This document updates these issues and other concerns regarding IE, with specific attention to the disease as it affects infants and children. In particular, the impact of increased survival for children with congenital heart disease (CHD) on the epidemiology of IE is updated, and newer tools useful for diagnosis and treatment in the pediatric population are reviewed. This review emphasizes changing management perspectives and discussion of new agents that have utility for treatment of resistant organisms. In addition, proper use of the diagnostic microbiology laboratory remains critical to the diagnosis and management of children with IE, and newer diagnostic guidelines that have improved sensitivity and specificity for confirming the diagnosis of IE will be reviewed. Because of improved infrastructure available for home intravenous therapy, an update on outpatient management, an increasingly accepted approach for stable patients who are at low risk for complications, will also be discussed. Finally, since the publication of the last AHA document on pediatric IE, recommendations for prevention of IE have been modified substantially, and the most current recommendations are incorporated from the perspective of pediatric cardiovascular concerns. In pediatrics, there are not likely to be any randomized controlled trials for treatment of IE, which posed a challenge for the writing group in compiling recommendations. Therefore, many of the indications are based on consensus. In cases of strong consensus that an intervention be considered as standard-of-care practice with …