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Bacterial Endocarditis

  • Bacterial endocarditis is an infection of the lining of the heart. Bacteria (germs) enter the bloodstream and lodge inside the heart, where they multiply and cause infection.

    • Bacterial endocarditis may occur in a person or any age who has congenital (present at birth) heart disease (CHD), or it may occur in people without heart disease.
    • Bacterial endocarditis does not occur very often, but when it does, it can cause serious heart damage.

    Here at Children’s Hospital Boston, the Boston Adult Congenital Heart (BACH) and Pulmonary Hypertension Program provides long-term inpatient and outpatient care and advanced therapeutic options for patients with congenital heart disease and/or pulmonary hypertension as they reach and progress through adulthood.

    The center promotes and supports clinical and scientific research for the advancement of care of these patients and is a leader in the education of providers caring for this unique population.

  • How does the infection occur?

    Ordinarily, the heart has a smooth lining, making it difficult for bacteria to stick to it. But people with congenital heart disease may have a rough area on the lining, which could be caused by conditions including:

    • pressure from an abnormal opening
    • a leaky valve—even after surgery, roughened areas may remain
    • scar tissue that forms after surgery
    • post-surgery patches that are used to redirect blood flow

    These rough areas inside the heart are opportune places for bacteria to build up and multiply.

    How does the bacteria get inside the body?

    Bacteria can enter the body in many ways. According to the American Heart Association (AHA), some of the most common ways include the following:

    • dental procedures (including professional teeth cleaning)
    • tonsillectomy or adenoidectomy (surgery to remove tonsils or adenoids)
    • examination of the respiratory passageways with an instrument known as a rigid bronchoscope
    • certain types of surgery on the respiratory passageways, the gastrointestinal tract or the urinary tract
    • gallbladder or prostate surgery

    Who is at risk for bacterial endocarditis?

    People with CHD may have an increased risk of developing an infection inside the heart. The greatest risk is in those with chronic cyanotic heart conditions and/or pulmonary hypertension/Eisenmenger's syndrome. Other conditions that put people at increased risk include those with:

    • defects that cause turbulent blood flow through heart chambers
    • areas of surgical repair with artificial materials such as patches or valve placements

    What are the symptoms of bacterial endocarditis?

    While each child may experience symptoms differently, the usual sign of bacterial endocarditis is when your child with CHD has prolonged fever for two to three days after a procedure in the mouth, intestinal tract or urinary tract. However, keep in mind that the infection may occur without a procedure. Other symptoms may include:

    • poor appetite
    • fatigue
    • joint pain
    • rash
    • weight loss

    How can bacterial endocarditis be prevented?

    An important step in preventing bacterial endocarditis is helping your child maintain excellent oral hygiene, including regular brushing and flossing.  Regular visits to the dentist for professional cleaning and check-ups are essential.

    Prophylaxis (preventative medicine) is another way to guard against bacterial endocarditis. In this case, your child might take one dose of an antibiotic before a procedure that could put him at risk. In most cases, the antibiotics can be given by mouth instead of through a shot or an intravenous (IV) line.

    If your child has had a simple patch or heart valve repair, he may only need pre-procedure prophylaxis antibiotics for the first six months following the surgery, until natural tissue grows over the artificial material and makes it smooth.

    New guidelines for preventing bacterial endocarditis

    In 2007, after an extensive review of the research, the American Heart Association's Endocarditis Committee and international experts developed new guidelines for the use of prophylaxis to prevent bacterial endocarditis.

    Previously, everyone with CHD would receive antibiotics before dental and other invasive procedures to prevent endocarditis. The new guidelines, however, recommend antibiotics before dental procedures only for the cardiac conditions associated with the highest risk of complications from endocarditis. These are:

    • prosthetic (artificial) heart valves
    • a previous history of endocarditis
    • congenital heart disease only in the following categories:
      • unrepaired cyanotic congenital heart conditions, including those with palliative shunts and conduits
      • congenital heart conditions completely repaired with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure
      • repaired congenital heart conditions with residual defects at the site or adjacent to the site of a prosthetic patch or device
      • cardiac transplantation recipients with cardiac valvular disease

    The new guidelines have also been endorsed by the Infectious Diseases Society of America, the Pediatric Infectious Disease Society and the American Dental Association.

    If your child is a candidate for preventive antibiotics, one of our doctors, nurses or cardiologists might give you a prescription.

    Please talk to your child's physician about any further questions you may have about risk factors or preventive measures.

  • How is bacterial endocarditis diagnosed?

    A blood test is the major test for bacterial endocarditis. We may need to take three to five blood samples in a 24-hour period to determine the presence of the bacteria. Other tests might include:

    • a urine sample may indicate the presence of infection
    • an echocardiogram (EKG or ECG) may detect an abnormality, such as a mass on a heart valve or on the heart wall surface. EKG is one of the simplest and fastest procedures used to evaluate the heart. Electrodes (small, plastic patches) are placed at certain locations on your child's chest, arms and legs. When the electrodes are connected to the EKG machine, the electrical activity of your child's heart is measured and printed out for the physician's information and interpretation.
  • What treatments are available for bacterial endocarditis?

    Bacterial endocarditis may cause severe damage to the inner lining of the heart and to the heart's valves. In most cases, the infection can be treated with strong antibiotics given through an IV over the course of several weeks. Heart damage may occur, however, before the infection can be controlled, so it's important to focus on prevention.

    If you would like an appointment or a second opinion, contact us.

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