Endocarditis

Question 1

Endocarditis risk factors:

Answer 1

HOST:
Immunosuppressed (diabetic, HIV, CKD, chemo)

BACTERAEMIA SOURCE
Poor oral hygeine
Procedures: Dental, GI, GU
Indwelling CVC
IVDU

VALVE
–> Rheumatic heart disease
–> Mechanical
–> Bicuspid aortic
–> Sclerosis
–> Prolapse

Question 2

Valve most commonly affected in IE:

Answer 2

Aortic most common native

R sided, think IVDU!!

Mechanical valves account for 30%*

Question 3

Common organisms in IE:

Answer 3

Staph aureus (most)
Strep viridans
HACEK
–> Haemophilus, actinobacter, cardiobacterium, Eikenella, Kingella)
–> These are often CULTURE NEGATIVE

Question 4

Clinical signs/ symptoms in IE:

Answer 4

Fever, malaise (90%)

Cardiac
- New murmur (50%) (regurg)
- AV block

Embolic
- Infarcts or abscesses in any organ
–>always consider IE in random abscess or septic joint
- Janeway lesions
- Osler nodes
- Splinter haemorrhages
- Roth’s spots
(not specific)

Question 5

Duke Criteria for IE:

Answer 5

Diagnostic:
2 major
OR
1 major, 3 minor
OR
5 minor

‘Possible’
1 + 1
OR
3

_________
MAJOR
- Culture + with IE organism (at least 2 sets)
- Echo +
- NEW regurg murmur

MINOR
- Risk factor
- Temp >38
- Vascular phenomena
(eg.Janeway, splinter)
- Immune phenomena
(eg. Osler, Roth, GN)
- Positive culture
(suboptimal collection, atypical)

Question 6

Treatment of IE:

Answer 6

NATIVE VALVE:
”Big Friendly Giant”
Benpen 1.2g 4 hourly
+ Fluclox 2g 4 hourly
+ Gent* 5mg/kg

MECHANICAL:
Swap benpen for Vancomycin 30mg/kg (MRSA)

NOT for anticoagulation (unless mechanical valve)

Question 7

What Ix should be performed in suspected IE:

Answer 7

• Blood cultures (+ in 90%)
  –> 2 sets, from 2 sites, 24 hours apart
• Echo

plus:
- Serology (HACEK testing)
- Urine (GN, renal abscess)
- +/- CT series to look for septic/embolic foci

Question 8

Prognosis in IE:

Answer 8

20% mortality at 1 year
10% if R sided, IVDU lesion

50% need eventual valve replacement.