Dixon Garth, Christov Georgi
aDepartment of Microbiology, Virology, Infection Prevention and Control bCardiothoracic Unit, Great Ormond Street Hospital, NHS Foundation Trust, London, UK.
Curr Opin Infect Dis. 2017 Jun;30(3):257-267. doi: 10.1097/QCO.0000000000000370.
Infective endocarditis in children remains a clinical challenge. Here, we review the impact of the updated 2015 American Heart Association and European Society of Cardiology guidelines on management as well as the significance of the new predisposing factors, diagnostic and treatment options, and the impact of the 2007-2008 change in prophylaxis recommendations.
The new 2015 infective endocarditis guidelines introduced the endocarditis team, added the new imaging modalities of computer tomography and PET-computer tomography into the diagnostic criteria and endorsed the concept of safety of relatively early surgical treatment. The impact of the restriction of infective endocarditis prophylaxis since the 2007-2008 American Heart Association and National Institute for Health and Care Excellence recommendations is uncertain, with some studies showing no change and other more recent studies showing increased incidence. The difficulties in adjusting for varying confounding factors are discussed. The relative proportion of the device-related infective endocarditis is increasing. Special attention is paid to relatively high incidence of percutaneous pulmonary valve implantation-related infective endocarditis with low proportion of positive echo signs, disproportionate shift in causative agents, and unusual complication of acute obstruction. The significance of incomplete neoendothelialization on the risk of infective endocarditis on intracardiac devices is also discussed.
The impact of changes in the infective endocarditis prophylaxis recommendations in pediatric patients is still uncertain. The device-related infective endocarditis has increasing importance, with the incidence on transcatheter implanted bovine jugular vein pulmonary valves being relatively high. The use of novel imaging, laboratory diagnostic techniques, and relatively early surgery in particular circumstances is important for management of paediatric infective endocarditis.
儿童感染性心内膜炎仍然是一项临床挑战。在此，我们综述2015年美国心脏协会和欧洲心脏病学会更新指南对管理的影响，以及新的易感因素、诊断和治疗选择的意义，还有2007 - 2008年预防建议改变的影响。
2015年新的感染性心内膜炎指南引入了心内膜炎团队，将计算机断层扫描和PET - 计算机断层扫描等新的成像模式纳入诊断标准，并认可了相对早期手术治疗安全性的概念。自2007 - 2008年美国心脏协会和英国国家卫生与临床优化研究所发布建议以来，感染性心内膜炎预防措施受限的影响尚不确定，一些研究显示无变化，而其他近期研究显示发病率增加。文中讨论了调整各种混杂因素的困难。与装置相关的感染性心内膜炎的相对比例正在增加。特别关注经皮肺动脉瓣植入相关感染性心内膜炎的发病率相对较高，其超声心动图阳性体征比例低、致病病原体不成比例的变化以及急性梗阻这一不寻常并发症。还讨论了不完全新内膜化对心内装置感染性心内膜炎风险的意义。
儿科患者感染性心内膜炎预防建议变化的影响仍不确定。与装置相关的感染性心内膜炎日益重要，经导管植入牛颈静脉肺动脉瓣的感染率相对较高。使用新型成像、实验室诊断技术以及在特定情况下相对早期的手术对于儿科感染性心内膜炎的管理很重要。
