Infective Endocarditis Flashcards
Endocarditis is the inflammation of the ___________ usually involving the valves
Endocardium (inner layer of the heart)
Endocarditis lesions are known as vegetations
Clinical Presentation of endocarditis
“From Jane”
F
R
O
M
J
A
N
E
Fever
Roth Spots
Osler nodes
Malaise
Janeway lesions
Anemia
Nailed
Emboli
Night sweats, weight loss, dyspnea, chest pain, headache, sepsis, acute heart failure
If infective endocarditis is left untreated, it is associated with _____
100% mortality
Risk factors for Infective endocarditis include:
1. Male
2. >60
3
4
5
3 IVDU
4 Structural heart disease
5 poor dentition/dental infections
3 groups of organisms that cause the majority of infective endocarditis cases:
1
2
3
Staph (40%)
- common cause of health care associated
- s.aureas, mssa, mrsa
Strep (20%)
- likely source is odontogenic
- viridian group strep
Enterococci (10%)
- may be seen in patients with recent history of genitourinary/obstetric procedures or GI malignancy
The modified ____ criteria is the gold standard for diagnosis of infective endocarditis
Duke
Consider _______ measures for life threatening cases of heart failure secondary to valve damage or if these two bacteria are the cause of infective endocarditis
1. Brucella spp
2. Candida spp
surgical
Also if persistent emboli and complications, treatment failure, relapse etc
First step to therapy in IE ?
1.
Obtain blood cultures and susceptibility data
When does the duration of therapy begin for IE ?
From 1st day of negative blood cultures
Culture positive treatment of IE - Staphylococci
Native Valve
1. If MSSA:
2. MRSA and beta lactam (type 1) allergy:
Prosthetic valve
1. If methicillin sensitive:
2: if methicillin resistant:
Native Valve
1. Cloxacillin/Cefazolin x 6 weeks (x2 weeks if right sided uncomplicated)
2. Vancomycin x 6 weeks
Prosthetic Valve
1. cloxacillin/cefazolin + rifampin x 6 weeks + gentamicin x first 2 weeks
2. vancomycin + rifampin x 6 weeks + gentamicin x first 2 weeks
Culture positive treatment of Native valve IE - VGS/S.bovis/gallolyticus
Pen-susceptible (MIC<0.12)
1.
2.
3. Short course: Pen G or ceftriaxone + gentamicin
4. Beta-lactam allergy: Vanco x 4 weeks
Relatively pen resistant (MIC>0.12 - <0.5)
1.
2.
3. Beta-lactam allergy: Vanco x 4 weeks
Pen resistant (MIC >0.5)
1
2
3 Beta-lactam allergy: Vanco x 4-6 weeks
Pen-susceptible (MIC<0.12)
1. Pen G x 4 weeks
2. Ceftriaxone x 4 weeks
Relatively pen resistant (MIC>0.12 - <0.5)
1. PEN G x 4 weeks + gentamicin x 2 weeks
2. Ceftriaxone
Pen resistant (MIC >0.5)
1 Ampicillin or penicillin + gentamicin x 4-6 weeks
2 Ceftriaxone + gentamicin
Culture positive treatment of PROSTHETIC valve IE - VGS/S.bovis/gallolyticus
Pen-susceptible (MIC < 0.12)
1.
Relatively Pen resistant (MIC> 0.12)
1.
- For both: betalactam allergy = Vanco x 6 weeks
Pen-susceptible (MIC < 0.12)
1. PEN G or Ceftriaxone x 6 weeks +/- gentamicin x 2 weeks
Relatively Pen resistant (MIC> 0.12)
1. Pen G or Ceftriaxone + gentamicin x 6 weeks
Culture positive treatment of Enterococci IE
1.
2. Ampicillin + ceftriaxone x 6 weeks (if CrCl <50)
3. Beta-lactam allergy: Vanco x 6 weeks
1 PEN g/ Ampicillin + gentamicin x 4-6 weeks
4 weeks if native valve
Treatment of gram negative HACEK bacteria IE
1.
- Ceftriaxone x 4 weeks if native / 6 weeks prosthetic
Antibiotic prophylaxis of IE should be considered in these high risk groups:
1.
2.
3. Unprepared cyanotic congenital heart disease
4. repaired CHD with residual shunts or valvular regurgitation
5. Cardiac transplant recipients with valve regurgitation
- prosthetic valves
- previous IE
