Endocarditis Flashcards
Endocarditis Clinical features
Fever
New murmur or change in a murmur
Complications of endocarditis
Complications of endocarditis
Splinter hemorrhages Janeway lesions (flat and painless) Osler nodes (raised and painful) Roth spots in the eyes Brain (mycotic aneurysm) Kidney (hematuria, glomerulonephritis) Conjunctival petechiae Splenomegaly Septic emboli to the lungs
Endocarditis Diagnostic Tests
Blood culture (95%–99% sensitive) Transthoracic echocardiogram (60% sensitive but 95%–100% specific) Transesophageal echocardiogram (95% sensitive and specific)
while Establishing a Diagnosis of Culture Negative Endocarditis
The diagnosis is based on:
- -Oscillating vegetation on echocardiography
- Three minor criteria:
- Fever >100.3 F (38 C)
- Risk such as injection drug use or prosthetic valve
- Signs of embolic phenomena
- Three minor criteria:
Endocarditis The best initial empiric therapy is
vancomycin and gentamicin
When culture results are available, treat as
in the table “Treatment of
Endocarditis.”
Viridans streptococci Tx
Ceftriaxone for 4 weeks
Staphylococcus aureus (sensitive)
Oxacillin, nafcillin, or cefazolin
for 6 weeks
Fungal etiology, tx
Amphotericin and valve
replacement
Staphylococcus epidermidis or resistant
Staphylococcus
Vancomycin or daptomycin for 6
weeks
Enterococci
Ampicillin and gentamicin
Colon pathology is associated with
Streptococcus bovis and
Clostridium septicum.
Treatment of Resistant Organisms
Add an aminoglycoside and extend the duration of treatment
tipo genta, amika, tobra, spiro…
When Is Surgery the Answer for endocarditis?
- CHF from ruptured valve or chordae tendineae**
- Prosthetic valves
- Fungal endocarditis
- Abscess
- AV block
- Recurrent emboli while on antibiotics
what to do with prosthetic valve endocarditis + Staphylococcus?
Add rifampin
Treatment of Culture-Negative Endocarditis
ceftriaxone
HACEK meaning
Haemophilus aphrophilus Haemophilus parainfluenzae Actinobacillus Cardiobacterium Eikenella Kingella
Prophylaxis for Endocarditis. When, in a nutshell?
1 Significant cardiac defect
+
2 Risk of bacteremia
what do you mean with Significant cardiac defect
- Prosthetic valve
- Previous endocarditis
- Cardiac transplant recipient with valvulopathy
- Unrepaired cyanotic heart disease
what do you mean with Risk of bacteremia
- Dental work with blood
- Respiratory tract surgery that produces bacteremia
wich ATB for Endocarditis Prophylaxis
amoxicillin
if penicillin allergic, then clindamycin, azithromycin, or clarithromycin
__________ are the most
common causes of culture-negative
endocarditis. THO
Coxiella and Bartonella
