Endocarditis Flashcards
What is endocarditis?
Infection of the endothelium of the heart valves
What are risk factors for endocarditis?
Heart valve abnormality Prosthetic valves IV drug users IV lines Recent dental work Immunocompromised
What is the most common causative organism for endocarditis?
Staph aureus
What are the common causative organisms for endocarditis?
Staph aureus Viridans streptococci Enterococcus sp. Staph epidermis Atypicals (e.g. coxiella burnetii, chlamydia, legionella, mycoplasma)
What are the most characteristic symptoms for endocarditis?
New murmur + fever
What are the symptoms of acute endocarditis?
Sepsis
Cardiac failure
What are the symptoms of sub-acute endocarditis?
Fever, riggers New/changing murmur (mitral or aortic regurgitation) Weight loss Splenomegaly Clubbing Roth spots Janeway lesions Osler's nodes
What are Roth spots?
Boat shaped retinal haemorrhages with pale centre
What are Janeway lesions?
Painless palmar macules
What are Osler’s nodes?
Painful purle papules on finger pulps
What investigations are done for endocarditis?
Blood cultures
Serology if cultures negative (for atypical organisms)
Echocardiogram
Which examination confirms or excludes diagnosis of endocarditis?
Echocardiogram
What is the most likely causative organism in IVDU?
Staph aureus
What is the most likely causative organism in patients with recent dental work?
Viridans streptococci
What is the most likely causative organism in patients with prosthetic valves?
Staph epidermidis
How should blood cultures be taken?
3 sets > 12 hours apart
Before giving antibiotics
What are the most likely causative organisms in early prosthetic valve endocarditis?
Staph epidermidis or staph aureus
What sided endocarditis is more likely in IVDU?
Right-sided
What is the general management for endocarditis?
Empirical antibiotics
What antibiotics are given for native valve indolent (subacute) endocarditis?
Amoxicillin + gentamicin IV
What antibiotics are given for native valve severe sepsis (acute) endocarditis?
Flucloxacillin IV
What antibiotics are given for prosthetic valve or suspected MRSA endocarditis?
Vancomycin + gentamycin IV + rifampicin PO
What antibiotics are given for staph aureus endocarditis?
Flucloxacillin IV
What antibiotics are given for MRSA endocarditis?
Vancomycin IV + rifampicin PO
What antibiotics are given for viridian’s strep endocarditis?
Benzylpenicillin + gentamicin IV
What antibiotics are given for enterococcus sp. endocarditis?
Amoxicillin/vancomycin + gentamicin IV
What antibiotics are given for staph epidermidis endocarditis?
Vancomycin + gentamicin + refampicin
How long are antibiotics given for?
4-6 weeks
What is the treatment if unresponsive to antibiotics?
Surgery
