infective endocarditis

Question 1

what is endocarditis until proven otherwise

Answer 1

fever + new murmur

Question 2

pt at risk + fever >1wk

Answer 2

blood cultures

Question 3

risk factors

Answer 3

skin breaches: dermatitis, IV lines
renal failure 
immunosuppresion 
DM 
aortic/mitral valve disease
IVDU
congenital heart disease

Question 4

endocarditis - normal valves

Answer 4

acute course

commonly staph aureus

Question 5

endocarditis - abnormal valves

Answer 5

subacute course

Question 6

causative organisms

Answer 6

bacteria

• strep viridans
• staph aureus
• step bovis (need colonoscopy)

fungal

• candidia
• aspergillos

Question 7

clinical presentation

Answer 7

septic signs: fever, rigors, malaise, weight loss, clubbin
new murmur (or change to pre-existing one)
Roth spots
splinter haemorrhages
Osler’s nodes
janeway lesions

Question 8

diagnostic criteria name

Answer 8

modified duke’s criteria

Question 9

Ix

Answer 9

blood cultures- 3 sets at different times from different sites at peak of fever
FBC, CRP
urinalysis 
ECGs
ECHO
CXR
CT

Question 10

Mx

Answer 10

liase with microbiologist

antibx

Question 11

Mx - when to consider surgery

Answer 11

heart failure
valvular obstruction
repeated emboli
fungal IE
persistant bacteraemia
myocardial abscess

Question 12

antibx: blind therapy - native valve or prosthetic implanted >1yr

Answer 12

ampicillin, flucloxacillin + gentamicin

penicillin allergic: vancomycin and gentamicin

Question 13

antibx: blind therapy - prosthetic valve

Answer 13

vancomycin + gentamicin + rifampicin

Question 14

antibx: staph native valve

Answer 14

flucloxacillin >4wks

allergic or MRSA - vancomycin

Question 15

antibx: staph prosthetic valve

Answer 15

flucloxacillin + rifampicin + gent 6wks

vancoycin insead of Fluclox if MRSA/allergic

Question 16

antibx: strep

Answer 16

benzylpenicillin

or

benzylpenicillin + gentamicin (less resistant)