infective endocarditis

Question 1

what is infective endocarditis

Answer 1

endovascular infection in the heart, usually involves valves

Question 2

describe the aetiology of infective endocarditis

Answer 2

mixture of organisms in the bloodstream and abnormal cardiac endothelium that facilitates vegetation

Question 3

name some causes of abnormal cardiac endothelium

Answer 3

previous rheumatic heart disease
congenital heart disease
age related valvular degeneration
prosthetic heart valve

Question 4

who is at higher risk of having organisms in their blood

Answer 4

PWIDs
intravascular lines
sepsis

Question 5

name typical causative organisms of infective endocarditis

Answer 5

staph aureus - most common

viridans streptococci - most common in sub-acute IE, esp in pre-damaged native valves

staph epidermidis - most common in prosthetic valves

candida and staph aureus are common in PWIDs - R sided, usually tricuspid

Question 6

when does infective endocarditis occur in patients with a prosthetic valve

Answer 6

staph epidermidis

can occur at time of insertion or years later - co-incidental bacteraemia

Question 7

name atypical causes of IE

Answer 7

coxiella burnetti - farming, aortic valve
NACEK bacteria - poor dental hygiene
brucella - goats
fungi -immunocompromised, PWIDs, IV lines

Question 8

describe the clinical presentation of acute IE

Answer 8

overwhelming sepsis and heart failure

usually due to staph aureus

Question 9

describe the symptoms of subacute IE

Answer 9

malaise
fever
weight loss
tiredness
dyspnoea

Question 10

describe the clinical signs of IE (8)

Answer 10

new/ changing murmur
finger clubbing
splinter haemorrhages
splenomegaly
roth spots
janeway lesions
osler nodes
microscopic haematuria

Question 11

name investigations used for IE

Answer 11

blood cultures - 3 sets taken
echo - vegetations
serology if blood cultures negative to look for atypicals

Question 12

outline the empirical treatment for acute native valve IE

Answer 12

flucloxacillin IV

Question 13

outline the empirical treatment for subacute native valve IE

Answer 13

amoxicillin and gentamycin IV

Question 14

outline the empirical treatment for prosthetic valve IE

Answer 14

vancomycin and gentamycin IV, add rifampicin PO on days 3-5

Question 15

outline the empirical treatment for IE in suspected MRSA

Answer 15

vancomycin and gentamycin IV add rifampicin PO in days 3-5

Question 16

outline the empirical treatment for IE in PWIDs

Answer 16

flucloxacillin IV

Question 17

what is the treatment for staph aureus IE (not MRSA)

Answer 17

flucloxacillin IV

Question 18

what is the treatment for viridans streptococci IE

Answer 18

benzylpenicillin and gentamycin IV

Question 19

what is the treatment for staph epidermidis IE

Answer 19

vancomycin and gentamycin IV, add rifampicin PO on days 3-5

Question 20

what is the treatment for MRSA IE

Answer 20

vancomycin and gentamycin IV, add rifampicin PO on days 3-5

Question 21

what is the treatment for enterococcus sp. IE

Answer 21

amoxicillin/ vancomycin and gentamycin IV

Question 22

describe prophylaxis of IE

Answer 22

not routinely recommended

can be indicated in some cases e.g. pts with a prosthetic valve undergoing dental treatment