The IE prophylaxis impact studies details are summarized in Table 56.12 Table 56.12 Studies on Effect of 2007–2008 Change in Infective Endocarditis Prophylaxis Recommendations (2002 for France) Patient Age (Adults, Country Children, Mixed) NO CHANGE IN IE INCIDENCE Pasquali et 2002–2010 US (37 Children al20 centers) Duval et 3 annual: France Adult al255 1991, 1999, (national) 2008 DeSimone 1999–2013 US Mixed et al257 Mackie et 2002–2013 Canada Mixed al254 Gupta et 2000–2010 US Children al50 Bates et 2003–2014 US Children al258 Sakai 2001–2012 US Children Bizmark et al259 INCREASE IN IE INCIDENCE Pant et 2000–2011 US Mixed al260 Dayer et 2000–2013 UK Mixed al261 Study Reference Period No of Cases Remark 1157 Large pediatric IE study 411, 557, 488 National study — VGS IE incidence not increased 8055 3840 Increase but change of slope April 2011, decrease of Streptococcal IE Large pediatric IE study 841 Large pediatric study, no IE increase 3748 Large pediatric study, no difference of slope of increase, slight increase in VGS IE in 10to 17-year-olds 29,820– Increase 11 to >15/100,000/year (increase 47,134/year VGS) 19,804 Increase IE, Infective endocarditis; VGS, viridans group streptococci Studies on the impact of IE prophylaxis face the difficulties of adjustment of massive data for changes in various confounding factors There has been adjustment for the increase in total population number, but it is immensely difficult to adjust for the better record of cases and for the substantial rise in number of procedures for valve and device implantations Prophylaxis Cost-Effectiveness A recent paper reported the cost-effectiveness of a potential reintroduction of IE prophylaxis in the United Kingdom.252 Studies on cost-effectiveness face the difficulties of calculating the presumed health gains Endocarditis Team Patients with suspected pediatric IE might best be cared for at centers with access to a team including pediatric cardiologists, clinical microbiology/infectious disease specialists, and cardiac surgeons.1,2 These should also have access to cardiac CT and nuclear imaging including PET/CT, brain CT, and MRI There should be an interventional radiology service for insertion of long-term peripherally inserted central catheters for the antibiotic treatment There has to be access to services needed to handle complications from IE, such as neurology, neurosurgery, vascular surgeons, and orthopedic surgeons Annotated References AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee Chairs, Pettersson GB, Coselli JS, et al 2016 the American association for thoracic surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary J Thorac Cardiovasc Surg 2017;153(6):1241– 1258.e29 A recent update on recommendations for IE surgery Baddour LM, Wilson WR, Bayer AS, et al Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American heart association Circulation 2015;132(15):1435–1486 A must-read updated American guidelines for IE management Baltimore RS, Gewitz M, Baddour LM, et al American heart association rheumatic fever, Endocarditis, and kawasaki disease committee of the council on cardiovascular disease in the young and the council on cardiovascular and ...Endocarditis Team Patients with suspected pediatric IE might best be cared for at centers with access to a team including pediatric cardiologists, clinical microbiology/infectious disease specialists, and cardiac surgeons.1,2 These