Zusammenfassung
Eine Endokarditis stellt eine bedrohliche Komplikation bei Patienten mit angeborenen Herzfehlern dar. Ihre zeitgerechte Diagnosestellung ist wichtig, aber gelingt in der Praxis oft viel zu spät, weil vermeidbare Fehler gemacht werden. Besonders wichtig ist, dass bei herzkranken Kindern die Ursache von Fieber einwandfrei geklärt werden muss, bevor Antibiotika verordnet werden. Lässt sich kein Fokus für das Fieber finden, ist eine Blutentnahme zum Nachweis von Parametern einer bakteriellen Infektion, eine Echokardiografie zum Nachweis eventueller Vegetationen sowie die Abnahme mehrerer Blutkulturen zum Erregernachweis erforderlich. Häufigste Erreger der subakuten Form der Endokarditis sind vergrünende Streptokokken, die als Saprophyten im Oropharynx vorkommen. Daher ist eine gute Mund- und Zahnhygiene wichtig. Vor zahnärztlichen Eingriffen ist bei Hochrisiko-Patienten die orale Gebe eines Antibiotikums zur Endokarditisprophylaxe indiziert. Erreger von Endokarditiden mit hochakutem Verlauf sind häufig Staphylococcus-aureus-Stämme. Die Prognose dieser Erkrankung ist sehr ernst, in den letzten Jahren aber durch eine operative Intervention in der akuten Phase verbessert worden.
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Kramer, H.H. (2020). Infektiöse Endokarditis. In: Hoffmann, G.F., Lentze, M.J., Spranger, J., Zepp, F., Berner, R. (eds) Pädiatrie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-60300-0_210
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