Infective Endocarditis Flashcards
Most common IE
Gram +Ve - Staph Aureus
Poor oral hygiene IE
Gram +ve - Strep Viridans (Streptococcus sanguinis / mitis)
Gram -ve HACEK organisms
prosthetic heart valve surgery in the last 4 months
Gram +ve Strep Epidermis
Colorectal cancer IE
Gram +ve Strep Gallolyticus / Bovis
Elderly with UTI IE
Gram +ve Enterococcus faecalis
SLE IE
Gram -ve Libman Sacks
advanced malignancies
IE
Gram -ve Non-bacterial thromboembolic endocarditis
Farmers IE
Gram -ve Coxiella Burnetti
Body lice and poor living conditions IE
Gram -ve Bartonella Quintana
Fist fights or mouth bites IE
Gram -ve Eikenella Corrodens
RF for infective endocarditis
Intravenous drugs
Poor oral hygiene / dental surgery
Structural heart pathology
Valvular
Congenital
Hypertrophic Cardiomyopathy
Prosthetic heart valves or implantable cardiac devices.
CKD or immunocompromised
Hx of infective endocarditis or previous endocarditis
Presentation IE
Fever
Fatigue
Night Sweats
Muscle Aches
Anorexic
Examination findings IE
New or changing heart murmur
Splinter Haemorrhages
Petechiae
Janeway Lesions
Osler Nodes
Roth Spots
Splenomegaly
Finger clubbing.
Ix IE
Blood cultures - 3 samples, 6 hours apart from different sites.
Echo / TOE - may see vegetations
Criteria for IE
Dukes:
Two Major OR
One major + 3 minor OR
5 minor
Minor Criteria
Predisposition
Fever >38
Vascular phenomena (e.g., splenic infarction, intracranial haemorrhage and Janeway lesions)
Immunological phenomena (e.g., Osler’s nodes, Roth spots and glomerulonephritis)
Microbiological phenomena (e.g., positive cultures not qualifying as a major criterion)
Major duke criteria
Persistently positive blood cultures
Image findings - vegetations
Treatment IE
IV broad spec abx - amox + / - gentamicin
Penicillin allergy IE treatment
Vancomycin + / - gentamicin
Prothetic valve endocarditis treatment
Vancomycin plus rifampicin plus low-dose gentamicin
MRSA sensitive with Prosthetic valves Treatment
Flucloxacillin, rifampicin, and low-dose gentamicin
Duration of Abx treatment IE
4 weeks for native heart valves or 6 weeks for prosthetics
When is surgery required for IE
Severe valvular incompetence
Aortic abscess (often indicated by a lengthening PR interval)
Infections resistant to antibiotics/fungal infections
Cardiac failure refractory to standard medical treatment
Recurrent emboli after antibiotic therapy
Prophylaxis for IE
None unless:
if a patient at risk of infective endocarditis is undergoing a gastrointestinal or genitourinary procedure at a site where there is a suspected infection, they should receive antibiotics that cover organisms that cause endocarditis.
Complications IE
Heart valve damage, causing regurgitation
Heart failure
Infective and non-infective emboli (causing abscesses, strokes and splenic infarction)
Glomerulonephritis, causing renal impairment
