Infective endocarditis in children.

IE in children is associated primarily with underlying congenital structural heart lesions, predominantly septal defects or complex lesions involving septal defects. During the past 20 years IE associated with rheumatic heart disease has declined to a negligible number. Recently nosocomial catheter-associated bacteremia has been associated with the development of IE, especially in infants. Streptococci are most frequently associated with IE involving natural valves. Although streptococci have also been implicated in cases of IE associated with previous surgery or catheter-related infection, staphylococci, Gram-negative rod species and multiple infecting species are also encountered in this setting. Because infection can often be managed medically, removal of grafts or prosthetic valves is not necessary unless clinical or microbiologic failure occurs. Penicillin with or without an aminoglycoside is the regimen for most community-acquired streptococcal IE. A penicillinase-resistant beta-lactam generally is substituted for penicillin in IE caused by an unknown agent and is used in cases of staphylococcal IE. For IE caused by resistant staphylococci, vancomycin is the alternative agent. Currently there is limited information on the efficacy of alternative agents for treating IE caused by enterococci or staphylococci with multiple antibiotic resistance.