Infective Endocarditis Flashcards
What does HACEK stand for in IE?
Haemophilus, Aggregatibacter, cardiobacterium, Eikenella corrodens, Kingella kingae
What is empirical Therapy for IE?
NVE Suspected MSSA: Benpen + Flucloxacillin + Gentamicin
NVE Suspected MRSA (IVDU): replace benpen with Vancomycin
Allergy to pencillin: Vancomycin + Cefazolin + Gentamicin
PVE: Vancomycin + Flucloxacillin + Gentamicin
Duke’s Major Criteria for Endocarditis
1: Positive Blood Culture: staph, strep viridans, strep gallolyticus, HACEK, Community acquired enterococcus, 1x Coxiella Burnetti
2. Endocardial Involvement: vegetation or abscess or new dehiscence of prosthetic valve or new valvular regurgitation
What is a Janeway Lesion?
Nontender erythematous macule on palm/sole
- microabscesses with neutrophil infiltration in capillaries
Duke’s minor criteria
- Predisposition–IV drug abuse, Prosthetic heart valve
- Fever >38
- Immunologic Phenomenon (Glomerulonephritis, Osler nodes, Roth spots, RF)
- Vascular phenomenon (conjunctival hemorrhages, ICH, mycotic aneurysm, septic pulmonary infarct, major arterial emboli, Janeway lesions)
- Blood cultures that do not meet major criteria or serologic evidence of active IE infection
What are Osler Nodes and Roth Spots?
Osler Node: tender subcutaneous papulopustule on finger pad/toe pads
Roth Spot: oedematous haemorrhagic lesion on retina with pale centre
- vascular occlusion by microthrombi -> localised immune mediated vasculitis
What are the surgical Indications for IE?
- Associated valve dysfunction (usually AR/MR) causing HF signs and sx
- paravalvular extension of infection –> annular/aortic abscess, destructive penetrative lesion +/- heart block
- infection difficult to treat - fungi/MDR (VRE, pseudomonas)
- persistent bacteraemia and fever > 7 days
- early surgery for large vegetation 10mm - individualised risk assessment
What can cause Culture Negative Endocarditis?
Fastidious gram positive cocci Bartonella species Coxiella burnetti - Q fever Trophyeryma whipplei - whipple disease Brucella species Fungi Legionella species
How to treat staphylococcal endocarditis?
NVE MSSA: Flucloxacillin for 4-6 Weeks
Nonsevere reaction to penicillins: Cefazolin, Severe reaction to penicillins: Vancomycin
NVE MRSA: Vancomycin for 6 weeks (frequency dependent on weight and creatinine clearance)
MSSA PVE: Flucloxacillin for 6 weeks
Similarly if nonsevere reaction - cefazolin, if severe - vancomycin
MRSA PVE: Vancomycinnfor 6 weeks
How to treat HACEK Endocarditis?
Ceftriaxone for 4-6 weeks
OR
Cefotaxime for 4-6 weeks
Susceptible to penicillin and beta-lactamase negative Benpen for 4-6 weeks
Duration of therapy: NVE usually 4 weeks, PVE usually 6 weeks
What patients need prophylaxis for prevention of IE?
Prosthetic heart valves - mechanical and bioprosthetic and homograft
Prosthetic material used for cardiac valve repair - annuloplasty rings and chords
Prior history if IE
Unrepaired cyanotic heart disease
Repaired congenital heart disease with residual shunts or valvular regurgitation at the site or adjacent to the site of the prosthetic patch or prosthetic device
Repaired congenital heart defects with catheter based intervention - occlusion device or stent during first 6 months after
Valve regurgitation due to structurally abnormal valve in transplanted heart
What procedures require Endocarditis prophylaxis?
Dental work
Respiratory tract procedures Incision or biopsy of respiratory tract mucosa
Skin/soft tissue procedures
Which valve defect is most commonly associated with Infective Endocarditis?
Should be MVP with Regurg
otherwise - Mitral Stenosis
What risk factors increase risk of embolisation in IE?
Left side vegetation
Large vegetation
Microbiology: staph aureus, strep bovis
Presence of antiphospholipid antibodies
What is the most common bacteria causing endocarditis?
Strep Mutans
