Endocarditis

Question 1

Endocarditis prophylaxis guidelines

Answer 1

1. Patients with prosthetic valves
2. Patients with previous IE
3. Patients with congenital cyanotic heart disease
4. CHD requiring repair

Question 2

Prophylaxis guidelines

Answer 2

Amoxicillin or ampicillin 2gm oral or IV

Clindamycin 600mg oral or IV

Question 3

Post rheumatic fever exposure

Answer 3

Daily penicillin for at least 10 yrs or until 40yrs - whichever is longest

Question 4

Diagnosis of IE

Answer 4

TOE

Question 5

Criteria for diagnosis

1 major and 1 minor OR
3 minor

Answer 5

Major:

• 2 positive cultures with appropriate organisms or continually positive cultures
• Single positive culture for coxiella
• Imaging with IE lesion OR positive PET >3/12 since implantation

Minor:

• Predisposition
• Fever >38
• Embolic phenomena
• Immunogenic phenomena
• Micro not meeting major criteria

Question 6

Predictors of poor outcomes

Answer 6

Old age
Prosthetic valve
DM
Organ failure
Staph aureus, fungal infections or non-HACEK organisms
Large vegetations
Periannular complications - abscesses or fistula
ventricular dysfunction
Severe prosthetic valve dysfunction

Question 7

Choice of antibiotics

Answer 7

Wait for sensitivities

Acute, severely unwell = amp + gent + fluclox

Question 8

Indications for surgery

Answer 8

Heart failure unresponsive to medical therapy

Uncontrolled infection –> local complications

Fungal infections

Persisting positive blood cultures despite appropriate antibiotics

Prevention of embolism:

• if vegetation > 10mm after embolic event despite antibiotic treatment
• single vegetation >30mm
• Vegetation >10mm associated with severe stenosis or severe regurgitation