56 Infective Endocarditis Georgi Christov, Garth Dixon, Martin Kostolny Abstract Pediatric infective endocarditis (IE) remains a diagnostic and therapeutic challenge It has a lower incidence and better outcomes than IE in adults The predisposing factors in high-income countries have changed: although rheumatic heart disease–related IE has dramatically declined, there is a rise of the congenital heart disease–related, postprocedural, and device-related pediatric IE The mainstay of management of IE is the multidisciplinary approach coordinated by the endocarditis team Current guidelines for IE management in adults have been updated by the European Society of Cardiology (ESC) and American Heart Association (AHA) in 2015 and a specific pediatric statement has been issued Surgical guidelines have been updated 2016 The classic Duke diagnostic criteria have been modified and recently amended Positive blood culture (BC) remains essential Advances in molecular microbiology and use of polymerase chain reaction (PCR) techniques allow for better diagnosis BC-negative endocarditis requires serology investigations, as well as PCR on resected material Echo signs of IE are present in 80% to 90% of cases Negative echocardiogram does not 100% exclude IE For pediatric IE, transesophageal echo is rarely required in cases of technical difficulties of image acquisition and prosthetic valve IE Computed tomography (CT) and positron emission tomography (PET)CT have been added to the imaging major diagnostic criteria CT is a screening tool for pulmonary thromboembolism in right-sided IE and brain imaging for cerebral embolism in left-sided IE PET-CT is invaluable for prosthetic valve IE and electronic device IE Antibiotic treatment is mandatorily long For pediatric IE, the degree of illness should not be considered a limitation to surgical intervention Early surgery has proven advantage in certain indications Repair is always preferred to replacement whenever possible Keywords pediatric infective endocarditis; changing profile; device-related infective endocarditis; vegetation; echo signs of infective endocarditis; aortic root abscess; CT and PET-CT for IE; blood culture; blood culture negative ... management in adults have been updated by the European Society of Cardiology (ESC) and American Heart Association (AHA) in 2015 and a specific pediatric statement has been issued Surgical guidelines have been... rheumatic heart disease–related IE has dramatically declined, there is a rise of the congenital heart disease–related, postprocedural, and device-related pediatric IE The mainstay of management of IE is the multidisciplinary approach coordinated by the endocarditis team...Infective Endocarditis Georgi Christov, Garth Dixon, Martin Kostolny Abstract Pediatric infective endocarditis (IE) remains a diagnostic and therapeutic challenge It has a lower incidence and better outcomes than IE in adults