Infective Endocarditis Flashcards
What is the critical information in infective endocarditis?
Where the infection is?
Acute or subacute?
How it is acquired?
What are the major pathogens in IE?
Viridans strep
Streptococcus pyogenes
Staphylococcus aureus
Staphylococcus epidermidis
Which invasive procedures increase the risk of IE?
Dental procedures
GI surgery
Vascular catheters
Risk factors for IE?
MV prolapse Rheumatic HD Congenital HD Degenerative HD IVDA Alcohol/DM Indwelling devices
How does IE occur?
Mechanical endothelial damage Turbulent flow (venturi effect) Inflammation
Symptoms of IE
Fever/Chills Night sweats, malaise, fatigue Weight loss Arthralgia Headache
Signs of IE?
Prolonged PR Murmur Patechial haemorrhage Splinter haemorrhage Janeway lesions (palms) Osler nodes (painful, fingers) Roth spots (eyes)
Investigations for IE?
Bloods culture BEFORE AntiB (3 sets and sites, 30m apart) FBC, CRP, U+E Urinalysis ECG Transthoracic echo
Most likely prosthetic valve IE?
Staphylococcus epidermidis
Most likely Native valve IE?
Viridans alpha-haemolytic streptococci
Most likely pathogen IVDA IE?
Staphylococcus aureus
Expected PR interval in IE?
> 0.2s
How is definite infective endocarditis diagnosed?
Dukes Criteria
2maj, 1maj3min, 5min
What are the major criteria for IE?
Positive blood cultures
Positive imaging for IE
What are the minor criteria for IE?
Predisposition Fever >38C Vascular phenomena Immunological phenomena Microbiological evidence
What must be known for treatment to take place?
Previous AntiB therapy
Native valve or prosthesis?
Antibiotic therapy for community acquired native valve/late prosthetic IE?
Ampicillin
Flucloxacillin
Gentamicin
Antibiotic therapy for community acquired native valve/late prosthetic IE? (penicillin allergy)
Vancomycin
Gentamicin
Antibiotic therapy for early prosthetic valve endocarditis and healthcare associated?
Vancomycin
Gentamicin
Rifampicin
Indications for surgery in IE?
Heart failure (valve regurge)
Uncontrolled infection
Prevention of systemic emboli
How can IE be prevented?
Antibiotic prophylaxis in patients at risk of IE
At risk undergoing dental treatment
Good oral hygiene
Aseptic measures during venous catheter manipulation
Preventative measures for IE?
Dental/skin hygiene Disinfecting wounds Decrease chronic carriage AntiB for any infection No self medicating antiB No piercing/tattoos Limiting catheter use/invasive procedures
