Infective Endocarditis Flashcards
What are causes of abnormal endothelium?
Abnormal valves - rheumatic, congenital bicuspid aortic valve, degenerative (AS)
Prosthetic heart valves
Unrepaired congenital cyanotic heart diseases
Intracardiac device - PPM/ICD
Common organisms in native valve endocarditis
Viridans streptococci Staph aureus Strep bovis Enterococci HACEK
Common organisms in IVDU
Staph aureus - most common
Streptococci
Enterococci
Fungi + GNB - less common
Common source of bacteraemia
Oral flora - dental work
Bowel flora - underlying bowel disease
Skin flora - IVC, central access, skin surgeries
IVDU
Common organisms in prosthetic infections
Early infection (less than 2 months)
- staph aureus
- coag negative staph
Late infection
- same organisms as native valve IE
Vascular phenomenon seen in IE
Arterial embolism - stroke, renal, splenic abscess/infarcts Pulmonary infarcts Intracranial haemorrhage Mycotic aneurysm
Immunological phenomenon seen in IE
Glomerulonephritis
Oslers nodes
Roth spot
Rheumatoid factor
Dukes criteria
Definite: 2 major, 1 major + 3 minor or 5 minor
Major:
- positive blood culture from typical organism
- endocardial vegetations on ECHO
Minor:
- fever
- predisposition –> IVDU, predisposing heart condition
- vascular phenomenon
- immunological phenomenon
- suggestive microbiology
Complications of IE
Congestive heart failure Embolisation - cerebral most common Periannular extension of infection Splenic abscess Mycotic aneursym
Risk factors for death
Increased age Staph aureus Heart failure Cerebrovascular and embolic events Healthcare associated IE
Indications for surgery
Heart failure due to valvular regurgitation
Elevated LV end diastolic pressure or pul HTN
Heart block
Annular aortic abscess
Fistula
Mitral leaflet perforation
Fungal or resistant organism
Antibiotics for strep viridans IE
Penicillin and gentamicin
Also used in enterococcus but longer duration
Antibiotics for Staph aureus
Flucloxacillin
+ rifampicin and gentamicin if prosthetic valve
If MRSA - vancomycin
Antibiotics for culture negative IE
Ceftriaxone and gentamicin
Conditions for which antibiotic prophylaxis for IE is required
Prosthetic heart valve
Rheumatic valvular heart disease
Previous endocarditis
Unrepaired cyanotic congenital heart disease
Surgical repair of congenital heart disease within 6m
