Infective Endocarditis

Clinical Description

Infection of the endocardium, mostly affecting the valves.

Signs and Symptoms

Duke’s criteria

Major Criteria

• 1. Blood culture positive for typical microorganism (e.g., Staphylococcus aureus, Enterococcus, Viridans streptococcus)
• 2. Echocardiogram showing valvular vegetation

Minor Criteria

• 1. Predisposing cardiac lesion
• 2. Temperature >38°C
• 3. Embolic phenomena (e.g., stroke, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjuctival haemorrhage or Janeway lesions)
• 4. Immunologic phenomena (e.g., glomerulonephritis, Osler’s nodes, Roth spots, positive rheumatoid factor)
• 5. Positive blood culture not meeting above criteria

Definite infective Endocarditis

• 2 major or 1 major plus 3 minor criteria

Possible Infective Endocarditis

• 1 major and 1 minor OR 3 minor criteria

Investigations

• FBC, blood culture: 3 samples, 12 hours apart, inflammatory markers: ESR, CRP, urine dipstick, echocardiography

Treatment

• IV benzyl Penicillin (50 000 IU/kg every 4-6 hours for 6 weeks and
• Gentamicin IV (3 mg/kg OD) for 2 weeks and
• IV Flucloxacillin 50mg/kg (to max 2g) IV QDS for 6 weeks

OR

• IV Benzyl Penicillin 50 000 IU/kg IV every 6 hours for 6 weeks and Gentamicin 3mg/kg IV od for 2 weeks. Please monitor renal function when giving gentamicin.

OR

• Ceftriaxone 100mg/kg (to max 2g) IV OD for 6 weeks

Adjust antibiotics as guided by culture and sensitivity.

Complications

• Stroke
• Metastatic infection (e.g., septic pulmonary infarcts, gangrenous foot)
• Thromboembolic phenomenon

Complications and Referral Criteria

All children with infective endocarditis to tertiary facility.