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Infective endocarditis
This document discusses the management, treatment, and prevention of infective endocarditis (IE) in pediatric patients. It states that treatment should involve collaboration between infectious disease specialists, cardiologists, and cardiac surgeons. Antibiotic therapy is necessary to prevent further damage and is based on factors like the patient's age, clinical presentation, and likely causative organisms. Surgical intervention may be required for severe valve involvement, complications like aneurysms, or if antibiotics fail to reduce symptoms within 7-10 days. Outcomes can be poor, with mortality around 20-25% despite treatment due to complications like heart failure, embolisms, and abscesses. Proper management of infections and aseptic technique for heart procedures can help reduce
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Infective endocarditis
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- 3. ►Treatment of IEin pediatric patients should be provided through collaboration among I.D.specialists, cardiologists, and cardiac surgeons ► Specific therapy is determined on a case by case basis and involves the use of antimicrobial agents and, when necessary, surgical intervention.
- 4. ANTIBIOTIC THERAPHY ►To preventfurther endocardial damage and complications, it is imperative that antibiotic therapy be initiated promptly in patients with suspected IE ► Antibiotic regimens for IE are based on the patient’s age, clinical presentation,cardiac status, and organisms most commonly isolated in infections. IV bactericidal antibiotics are necessary for the treatment of IE
- 5. Empirical Theraphy ► Empiricaltherapy before the identifiable agent is recovered may be initiated with vancomycin plus gentamicin in patients without a prosthetic valve and when there is a high risk of S. aureus, enterococcus, or viridans streptococci (the 3 most common organisms). ►A total of 4-6 weeks treatment is usually required.
- 6. Treatment ► In nonstaphylococcaldisease, bacteremia usually resolves in 24-48 hr, whereas fever resolves in 5-6 days with appropriate antibiotic therapy. Resolution with staphylococcal disease takes longer. ►If the infection occurs on a valve and induces or increases symptoms and signs of heart failure, appropriate therapy should be instituted, including diuretics, afterload reducing agents, and in some cases, digitalis
- 11. Surgery Indication ►Surgical interventionfor I.E is indicated for severe aortic, mitral or prosthetic valve involvement with intractable heart failure. ►Mycotic aneurysm, rupture of an aortic sinus, intraseptal abscess causing complete heart block, or dehiscence of an intracardiac patch requires an emergency operation.
- 12. Indications for Surgery ►Failureto sterilize the blood despite adequate antibiotic levels in 7-10 days in the absence of extracardiac infection, ►Myocardial abscess, ►Recurrent emboli, ►Increasing size of vegetations while receiving therapy. ►Vegetations (aortic, mitral, prosthetic valve) >10-15 mm are at high risk of embolism
- 13. Indications for surgery ►Activeinfection is not a contraindication for surgery if patient is critically sick ►Removal of vegetations and, valve replacement may be lifesaving, and sustained antibiotic administration will prevent reinfection. ►Replacement of infected prosthetic valves carries a higher risk
- 15. Prognosis and complications ►Mortality20-25% despite antibiotics use, ►Serious morbidity 50-60% in documented I.E due to heart failure secondary to aortic , mitral valves vegetations. ►Myocardial abscesses toxic myocarditis, and fatal arrythmias ►Systemic emboli with CNS menifestations, pulmonary emboli are usually lethal
- 16. Prognosis and complications ►Mycoticaneurysms, rupture of a sinus of Valsalva, obstruction of a valve secondary to large vegetations. ►Acquired VSD, Heart block due to involvement(abscess) of conduction system ► Additional complications include meningitis, osteomyelitis, arthritis, renal abscess, purulent pericarditis, and immune complex- mediated glomerulonephritis
- 17. Fungal Endocarditis ►Difficult tomanage, poor prognosis. ►Encountered after cardiac surgery in debilitated, immunocompromised, patients and those on prolong antibiotics. ►Drug of choice Amphotericine-B and Flourocytocine. ►Surgery to excise infected tissue with limited success ►rTPA help to lyse vegetation and avoid surgery in high risk patients
- 19. Prevention/Prophylaxis Revised AHA recomedation2007 ►A substantial reduction in the number of patients who require prophylactic treatment and the procedures requiring coverage was recommended (in revised guidelines) ►IE more frequently associated with random bacteremias than dental or GI procedure ►Routine prohylaxis may prevent small cases ►Risk of antibiotics adverse events exceeds the benefit of prophlaxis
- 21. Vigorous treatment ofsepsis and local infections and careful asepsis during heart surgery and catheterization reduce the incidence of infective endocarditis