Profilaxis de la endocarditis infecciosa

No siempre es posible la prevención de la infección del endocardio mediante antibióticos. En unos casos, la bacteriemia no se identifica y en otros la bacteriemia ocurre de forma espontánea, no pudiéndose prevenir. Muchos de los casos de endocarditis valvular son producidos por organismos procedentes de la cavidad bucal. Con el fin de reducir al máximo estas fuentes de bacteriemia, todos los niños de riesgo deben ser instruidos para conseguir y mantener una correcta salud bucal.

La profilaxis es particularmente importante en los niños en los que la endocarditis se asocia a altos índices de morbilidad y de mortalidad. Las alteraciones cardiacas han sido estratificadas en tres categorías de riesgo (Tabla 9). La profilaxis se recomienda en pacientes con riesgo moderado y elevado. Los niños de bajo riesgo tienen las mismas posibilidades para desarrollar endocarditis que la población general (Tablas 10 y 11).

En conclusión, el aumento observado de frecuencia de endocarditis infecciosa en niños durante los últimos años hace necesario que los pediatras, así como los especialistas, consideren este diagnóstico en niños. Los pacientes con cardiopatías congénitas sometidos a cirugías complejas, en los que se han implantado injertos vasculares, parches, o prótesis valvulares cardiacas, presentan un riesgo creciente de desarrollar una EI. No obstante, los niños con corazones normales también pueden desarrollar endocarditis infecciosa.

Bibliografía recomendada

- Rheumatic fever and rheumatic heart disease. World Health Organ Tech Rep Ser 2004; 923: 1-122.
- Ako J, Ikari Y, Hatori M, Hara K, Ouchi Y. Changing spectrum of infective endocarditis: review of 194 episodes over 20 years. Circ J. 2003; 67: 3-7.
- Aronin SI, Mukherjee SK, West JC, et al. Review of pneumococcal endocarditis in adults in the penicillin era. Clin Infect Dis. 1998; 26: 165-71.
- Awadallah SM, Kavey RE, Byrum CJ, et al. The changing pattern of infective endocarditis in childhood. Am J Cardiol. 1991; 68: 90-4.
- Bayer A, Bolger AF, Taubert KA, et al. Diagnosis and management of infective endocarditis and its complications. Circulation. 1998; 98: 2936-48.
- Bricker JT, Latson LA, Huhta JC, et al. Echocardiographic evaluation of endocarditis in children. Clin Pediatr. 1985; 24: 312-317.
- Brook MM. Pediatric bacterial endocarditis. Treatment and prophylaxis. Pediatr Clin North Am. 1999; 46:275-87.
- Citak M, Rees A, Mavroudis C. Surgical management of infective endocarditis in children. Ann Thorac Surg. 1992; 54: 755-60.
- Coward K, Tucker N, Darville T. Infective endocarditis in Arkansan children from 1990 through 2002. Pediatr Infect Dis. J 2003; 22: 1048-52.
- Croft CH, Woodward W, Elliott A, et al. Analysis of surgical versus medical therapy in active complicated native valve infective endocarditis. Am J Cardiol. 1983; 51: 1650-55.
- Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis: recommendations by the American Heart Association. JAMA. 1997; 277: 1794-801.
- Del Pont JM, De Cicco LT, Vartalitis C, et al. Infective endocarditis in children: clinical analyses and evaluation of two diagnostic criteria. Pediatr Infect Dis J. 1995; 14: 1079-86.
- Dodo H, Child JS. Infective endocarditis in the adult with congenital heart disease. Cardiol Clin. 1996; 11: 383-92.
- Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994; 96: 200- 9.
- Ferrieri P, Gewitz MH, Gerber MA, Newburger JW, Dajani AS, Shulman ST, et al. Unique features of infective endocarditis in childhood. Circulation 2002; 105: 2115-27.
- Geva T, Frand M. Infective endocarditis in children with congenital heart disease: the changing spectrum, 1965-85. Eur Heart J. 1988; 9: 1244-9.
- Humpl T, McCrindle BW, Smallhorn JF. The relative roles of transthoracic compared with transesophageal echocardiography in children with suspected infective endocarditis. J Am Coll Cardiol. 2003; 41: 2068-71.
- Johnson DH, Rosenthal A, Nadas AS. A forty-year review of bacterial endocarditis in infancy and childhood. Circulation. 1975; 51: 581-8.
- Karalis DG, Bansal RC, Hauck AJ, et al. Transesophageal echocardiographic recognition of subaortic complications in aortic valve endocarditis: clinical and surgical implications. Circulation. 1992; 86: 353-62.
- Karl T, Wensley D, Stark J, et al. Infective endocarditis in children with congenital heart disease: comparison of selected features in patients with surgical correction or palliation and those without. Br Heart J. 1987; 58: 57-65.
- Kavey RE, Frank DM, Byrum CJ, et al. Two-dimensional echocardiographic assessment of infective endocarditis in children. Am J Dis Child. 1983; 137: 851-6.
- Knirsch W, Hassberg D, Beyer A, Teufel T, Pees C, Uhlemann F, Lange PE. Knowledge, compliance and practice of antibiotic endocarditis prophylaxis of patients with congenital heart disease. Pediatr Cardiol. 2003; 24: 344-9.
- Lefort A, Mainardi JL, Selton-Suty C, et al. Streptococcus pneumoniae endocarditis in adults: a multicenter study in France in the era of penicillin resistance (1991-1998). The Pneumococcal Endocarditis Study Group. Medicine. 2000; 79: 327-37.
- Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000; 30: 633-8.
- Maltezou HC, Raoult D. Q fever in children. Lancet Infect Dis. 2002; 2: 686-91.
- Martin JM, Neches WH, Wald ER. Infective endocarditis: 35 years of experience at a children's hospital. Clin Infect Dis. 1997; 24: 669-75.
- Michelfelder EC, Ochsner JE, Khoury P, Kimball TR. Does assessment of pretest probability of disease improve the utility of echocardiography in suspected endocarditis in children? J Pediatr. 2003; 142: 263-7.
- Milazzo AS, Li JS. Bacterial endocarditis in infants and children. Ped Infect Dis J. 2001; 20: 799-801.
- Millard DD, Shulman ST. The changing spectrum of neonatal endocarditis. Clin Perinatol. 1988; 15: 587-608.
- Morris CD, Reller MD, Menashe VD. Thirty-year incidence of infective endocarditis after surgery for congenital heart defect. JAMA 1998; 279: 599-603.
- Mugge A, Daniel WG, Frank G, et al. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol. 1989; 14: 631-8.
- Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004; 110: 2747-71.
- Noel GJ, O'Loughlin JE, Edelson PJ. Neonatal Staphylococcus epidermidis right-sided endocarditis: description of five catheterized infants. Pediatrics. 1988; 82: 234-9.
- Oelberg DG, Fisher DJ, Gross DM, et al. Endocarditis in high-risk neonates. Pediatrics 1983; 71: 392-7.
- Parras F, Bouza I, Romero J, Buzon L, Quero F, Brito J, et al. Infectious endocarditis in children. Pediatr Cardiol. 1990; 11: 77-81.
- Pierrotti LC, Baddour LM. Fungal endocarditis, 1995-2000. Chest 2002; 122 :302-10.
- Sable CA, Rome JJ, Martin GR, Patel KM, Karr SS. Indications for echocardiography in the diagnosis of infective endocarditis in children Am J Cardiol 1995; 75: 801-4.
- Saiman L, Prince A, Gersony WM. Pediatric infective endocarditis in the modern era. J Pediatr. 1993; 122: 847-53.
- Sexton DJ, Tenenbaum MJ, Wilson WR, et al. Ceftriaxone once daily for four weeks compared with ceftriaxone plus gentamicin once daily for two weeks for treatment of endocarditis due to penicillin-susceptible streptococci. Endocarditis Treatment Consortium Group. Clin Infect Dis. 1998; 27: 1470-4.
- Soxman JA. Subacute bacterial endocarditis: considerations for the pediatric patients. J Am Dent Assoc. 2000; 131: 668-9.
- Steckelberg JM, Wilson WR. Risk factors for infective endocarditis. Infect Dis Clin North Am. 1993; 7: 9-19.
- Stockheim JA, Chadwick EG, Kessler S, et al. Are the Duke criteria superior to Beth Israel criteria for diagnosis of infective endocarditis in children? Clin Infect Dis. 1998; 27: 1451-6.
- Symchych PS, Krauss AN, Winchester P. Endocarditis following intracardiac placement of umbilical venous catheters in neonates. J Pediatr. 1977; 90: 287-9.
- Tissieres P, Gervaix A, Beghetti M, Jaeggi ET. Value and limitations of the von Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children. Pediatrics. 2003; 112: e467.
- Tolan RW Jr, Kleiman MB, Frank M, et al. Operative intervention in active endocarditis in children: report of a series of cases and review. Clin Infect Dis. 1992; 14: 852-62.
- Van Hare GF, Ben-Shachar G, Liebman J, et al. Infective endocarditis in infants and children during the past 10 years: a decade of change. Am Heart J. 1984; 107: 1235-40.
- Wilson WR, Karchmer AW, Dajani AS, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA 1995; 274: 1706-13.

 

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