Infective Endocarditis

Question 1

What are the most common agents causing infective endocarditis in:

• General population
• IVDUs
• People with prosthetic valves

Answer 1

• General population
  
  • Strep viridans
• IVDUs
  
  • S. aureus
• People with prosthetic valves
  
  • S. epidermidis

Question 2

What are the risk factors for bacterial endocarditis?

Answer 2

• Previous IE
• Staph bacteraemia
• Valvular/congenital heart disease (turbulent blood flow)
• IVDU

Question 3

What signs might you find on history and examination in someone with bacterial endocarditis?

Answer 3

• Fever and constitutional symptoms
• Arthralgias/headache/meningism (emboli)
• SOB (CCF sign)
• New/worsening murmur
• Clubbing (emboli)
• Janeway lesions/Osler nodes/Roth spots/splinter haemorrhages

Question 4

How might you work up someone with suspected bacterial endocarditis?

Answer 4

• FBE (often a normocytic anaemia present)
• Urinalysis (sediment may be present)
• Blood cultures x 3
• ECG and echo

Question 5

What are the empiric antibiotics used for treatment of bacterial endocarditis?

Answer 5

• Native valve - gentamicin, ben-pen and flucloxacillin
• Prosthetic - replace ben-pen with vancomycin