Infective Endocarditis Flashcards
What is infective endocarditis?
Rare but potentially life-threatening infection of the heart’s inner lining or valves
What are the risk factors for infective endocarditis?
- Previous episodes of endocarditis
- Previous normal valve (Mitral commonly affected)
- Rheumatic valve disease
- Prosthetic valves
- Congenital heart defects
- IV drug users (Tricuspid commonly affected)
- Recent piercings
What is the most common cause of infective endocarditis in IV drug users?
Staphylococcus aureus (common in IVDU too)
Which bacteria is a common cause of endocarditis in patients with poor dental hygiene?
Staphylococcus viridans
What causes endocarditis in patients with prosthetic valve surgery?
Coagulase-negative Staphylococci such as Staphylococcus epidermidis
What is a common cause of endocarditis in patients with colorectal cancer?
Streptococcus bovis
What is Libman-Sacks endocarditis associated with?
Systemic lupus erythematosus (SLE)
What is marantic endocarditis associated with?
Malignancy
What criteria is used for diagnosing infective endocarditis?
Modified Duke Criteria
What are the Modified Duke Criteria for diagnosing infective endocarditis?
Any of the following options:
* Pathological criteria
* 2 major criteria
* 1 major and 3 minor criteria
* 5 minor criteria
What constitutes pathological criteria in the diagnosis of infective endocarditis?
Histology/microbiology of pathological material obtained at autopsy or cardiac surgery
What are the major criteria for diagnosing infective endocarditis? (BEV)
- Positive Blood cultures (2 x cultures)
- Echocardiogram
- Valvular regurgitation (new murmur)
What are the minor criteria for diagnosing infective endocarditis? (TIMER)
- Temperature >38
- Immunological signs: Osler’s nodes, Roth spots, Glomerulonephritis
- Microbiological evidence does NOT meet major criteria
- Embolic phenomenon (vascular): major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
- Risk factors (predisposing heart condition OR IV drug use)
What are poor prognosis factors in infective endocarditis?
- Staph. aureus infections (mortality 30%)
- Prosthetic valve
- Culture negative endocarditis - blood culture sterile
What are the management options for infective endocarditis?
- Antibiotic Treatment
- Surgical Treatment (infection removal/drainage, valve/cardiac repair, valve replacement)
Infective Endocarditis - Initial blind treatment
Amoxicillin (native valve)
Vancomycin + Rifampicin + low-dose gent (prosthetic valve)
Vancomycin + low-dose gent (Pen All/MRSA)
Infective Endocarditis - Native valve + Staph aureus
Flucloxacillin
(Pen All/MRSA + - Vaccomycin + Rifampicin)
Prosthetic valve + Staph aureus
Flucloxacillin + Rifampicin + low-dose gentamicin
(Pen All/MRSA + - Vaccomycin + Rifampicin + low-dose gentamicin )
What are the indications for surgical treatment in infective endocarditis?
- Severe valvular incompetence
- Aortic abscess
- Infections resistant to antibiotics/fungal infection
- Cardiac failure
- Recurrent emboli after antibiotic therapy
What is prophylaxis treatment for infective endocarditis?
Antibiotics given as a precaution to prevent infection
What are the guidelines for prophylaxis treatment?
- Investigate + promptly treat patients with infection who are at high risk of infective endocarditis
- Patients undergoing gastrointestinal or genitourinary procedures should be given prophylaxis antibiotics at the site of the procedure
Who are considered high-risk individuals for infective endocarditis?
- Patients with a pre-existing heart condition
- IV drug users
- Immunocompromised patients
What antibiotics are usually used for prophylaxis against infective endocarditis?
- Amoxicillin
- Clindamycin (for penicillin allergy)
