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Diagnostic work-up and current management strategies for infective endocarditis in the pediatric population
Yasin Essa1, Sameh M Said1,2
1Department of Surgery, Division of Pediatric and Adult Congenital Cardiac Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595 USA.
Insights
Infective endocarditis (IE) is rising in children due to congenital heart disease and medical interventions. Current guidelines for managing pediatric IE lack evidence, necessitating a review of this unique population.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Infective endocarditis (IE) presents a significant challenge in pediatric populations, marked by increasing incidence and severe outcomes.
- Improved survival rates for children with congenital heart diseases (CHDs), increased use of intracardiac prostheses, and catheter-related interventions contribute to the rising IE rates.
- Current management guidelines for pediatric IE are largely extrapolated from adult data, with a notable lack of specific evidence-based recommendations for children.
Purpose of the Study:
- To review the epidemiology, clinical presentations, microbiology, and outcomes of infective endocarditis in the pediatric population.
- To analyze the etiology and predisposing factors contributing to IE in children.
- To discuss and evaluate different treatment strategies tailored for pediatric IE cases.
Main Methods:
- This study is a narrative review of existing literature on infective endocarditis in children.
- The review synthesizes information regarding the causes, risk factors, and management approaches for pediatric IE.
- Data from various sources were analyzed to provide a comprehensive overview.
Main Results:
- The incidence of IE in children is increasing, linked to advancements in CHD care and medical device usage.
- Specific challenges exist in managing pediatric IE, including the impact of altered antibiotic prophylaxis guidelines.
- There is a critical need for evidence-based guidelines specific to the pediatric population.
Conclusions:
- Infective endocarditis in children requires specialized understanding due to unique epidemiological and clinical factors.
- Further research is essential to develop optimal, evidence-based management strategies for pediatric IE.
- A comprehensive approach considering etiology, predisposing factors, and tailored treatments is crucial for improving outcomes in children with IE.
Abstract:
Infective endocarditis (IE) remains a serious disease that is associated with significant morbidity and mortality, and despite the significant advances that have been made in understanding the disease process in past decades, its incidence appears to be on the rise recently. Endocarditis in children is no longer a rare occurrence. This appeared to be related to a combination of the improved survival of children with congenital heart diseases (CHDs), increase use of intracardiac protheses, and catheter-related interventions. The American Heart Association (AHA) 2007 guidelines reduced the recommendations for use of prophylactic antibiotics in those with CHDs which occurred despite the noticeable increase in endocarditis incidence around that time. In general, the recommendations for managing children with IE are derived from the adults' guidelines, and the evidence-base is lacking in many clinical scenarios. Understanding the epidemiology, clinical presentations, microbiology, and outcomes of different management strategies for endocarditis is needed to have a clear and optimal plan for these children. In the current narrative review, we discuss IE in the pediatric population in terms of etiology, predisposing factors, and different treatment strategies for this unique population.
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