Infective Endocarditis Flashcards
What is infective endocarditis?
Infection of the endocardium
What does infective endocarditis effect?
Heart valves
Interventricular septum
Chordae tendinae
Intra-cardiac devices
What is the outcome like for infective endocarditis?
Poor prognosis
High mortality
What effects the presentation of the disease?
Underlying cardiac disease
Microorganism involved
Presence/absence of complications
Underlying patient characteristics
Who is involved in the treatment of infective endocarditis?
Primary care physician/acute medicine Cardiologist Surgeons Microbiologists Infectious disease doctors Neurologists Neurosurgeons Radiologists Pathologists
What is the incidence rate in the general population?
3-10 episodes per 100,000 people
What is the incidence rate amongst 70-80 year olds?
14.5 episodes per 100,000 people
Which gender is more at risk of developing the disease?
Men are two times more likely
Which gender has the worse prognosis?
Women
What are the cardiac risk factors?
Mitral valve prolapse Ventricular septal defect Aortic stenosis Rheumatic heart disease Prosthetic heart valve Cardiac surgery Prior native IE Cardiac surgery for native IE Surgery for prosthetic IE Congenital heart disease Aortic regurgitation Mitral regurgitation
What are the non-cardiac risk factors of IE?
Injection drug usage Indwelling medical device Diabetes AIDs Chronic skin infections Burns Genitourinary infections or manipulations Alcoholic cirrhosis GI lesions Solid organ transplant Body lice Pneumonia Meningitis Infected animals
What are some common organisms responsible for IE?
Staph aureus Strep pneumoniae Corynebacterium Enterococcus Neisseria gonorrhoeae Bartonella
What are the different modes of acquisition?
Health care related
Community acquired
Intravenous drug abuse
What are the signs and symptoms?
Bacteraemic episodes Fever Fatigue Malaise Focal neurological signs Peripheral embolus/abscess Pulmonary embolus/abscess Immune complex deposition Congestive heart failure Murmurs
What are the immune complex depositions?
Splinter haemorrhages Vasculitic rash Roth spots Osler's nodes Laneway lesions Nephritis
When can signs be absent?
Elderly
After antibiotic treatment
Immunocompromised
IE involving less virulent/atypical organisms
What investigations should be done?
FBC CRP U+E's ESR blood cultures Urinalysis ECG Chest X-ray Echo
What are you looking for in a FBC?
Neutrophilic
What are you looking for in U+E’s?
Nephritis
Infection
Sepsis
How should the blood cultures be done before starting antibiotics?
3 sets at different sites with 6 or more hours between each
How should the blood cultures be done to check for severe sepsis/septic shock?
2 sets at different sites within 1 hour of each other
What are you looking for in urinalysis?
Positive for blood
What are you looking for on an ECG?
Conduction delay
What are you looking for on a CXR?
Heart failure
Pulmonary abscesses
When should a transoesophageal echo be done?
Whenever there is a high suspicion of IE and if the transthoracic echo is abnormal
When should there be a repeat TTE and TOE?
If there are new complications
In uncomplicated IE
What are the 3 most common species of microorganism that cause IE?
Streptococci
Enterococci
Staphylococcus
What are the different types of enterococci?
E.faecalis
E.faecium
E.durans
What are the different types of staphylococcus?
S.aureus
S.epidermidis
What are the major criteria of the modified Duke criteria?
Identifying organism
Providing evidence of infection anywhere within the heart
What is the minor criteria of the modified Duke criteria?
Focus on the endocarditis complex of clinical findings
What is the treatment of IE?
Antibiotics
Surgery
What antibiotic are used if it affects native valves?
IV Gentamicin + Amoxycillin
or
Gentamicin + IV Vancomycin
What antibiotics are used if it affects native valves and there is sepsis?
Gentamicin + IV Vancomycin
What antibiotic are used if it affects prosthetic valves?
Gentamicin + IV Vancomycin + Rifampicin
What fungi can cause IE?
Candida
Aspergillus
What are the possible complications of IE?
Heart failure Fistula formation Leaflet perforation Uncontrolled infection Abscess formation Atrioventricular heart block Embolism Prosthetic valve dysfunction
When should surgery be used to treat IE?
Intracardiac devices
Vegetation larger than 15mm
Embolism and vegetation larger than 10mm
When there are any complications
When should prophylaxis be used?
On highest risk patients
What is particularly important in terms of prophylaxis?
Good oral hygiene and regular dental reviews
