Infective endocarditis Flashcards
What is infective endocarditis
microbial infection of valvular or endocardial surface of heart
Can be native valve, prosthetic valve, or IVDU
What happens during infective endocarditis
thrombus forms on the endothelial surface, bacteria infect the site and proliferate
What valves are involved in infective endocarditis
Native: mitral valve
Prosthetic: site of prosthesis
IDU: tricuspid (R sided), then aortic
What are the native IE infective organisms
S. Aureus
What are the prosthetic IE infective organisms
Early: S. aureus and Coag negative staph
Late: Streptococci and S. aureus
What are the IDU IE infective organisms
S. Aureus
Streptococci
Enterococci
What are risk factors for IE
>60 y/o male IDU Poor dentition HIV chronic hemodialysis
What are symptoms of IE
fever, cough, dyspnea
Arthralgia’s
diarrhea, abd pain, back pain
What will you see on physical exam for IE
New regurgitant murmur
Petechiae, splinter hemorrhage, osler node (painful), Janeway lesions, roth spots
What are some differentials for IE
bacteremia (cath infection, skin cardiac prosthetic infection, osteomyelitis, meningitis, PNA, sepsis)
What diagnostic tests are the most important for diagnosing IE
blood cultures!
Also transthoracic echo (shows vegetation, abscess, or dehiscence)
TEE (higher sensitivity)
ECG, CXR, CT torso
What is the Major modified duke criteria
- 2 positive blood cultures
- Echo showing endocardial involvement
- New regurgitant murmur
What is the Minor modified duke criteria
- Predisposing condition
- Fever >38 C
- Vascular findings (aneurysm, emboli, pulm. infarct)
- Immunologic findings (osler nodes, etc.)
- Blood cultures not seeing major criteria
- Serologic evidence of infection
What gives you a definitive IE diagnosis based on Duke criteria
2 major OR
1 major and 3 minor OR
5 minor
(possible diagnosis if 1 major 1 minor, or 3 minor)
What are the diagnostic criteria for bacterial endocarditis
BE FIVE PM B- blood culture + E- Endocardial involvement F- fever I- immunologic V- vascular E- echo findings P- predisposition M- Microbiologic evidence
How do you treat IE
admit to hospital
empiric treatment
consult infectious disease
What is empiric treatment for IE
Vancomycin or Cephtriaxone
PV: Vancomycin + Gentamicin + Rifampin
What is treatment for Strep Viridians
Penicillin or Ceftriaxone (4 weeks) P or C plus Gentamicin (2 weeks) PV: Penicillin or Ceftriaxone (6 weeks) P or C plus Gentamicin (2 weeks)
What is the treatment for Other strep (not Viridans)
Penicillin
Cephazolin
Ceftriaxone
What is the treatment for enterococci
Penicillin or Ampicillin
PLUS Gentamicin or Ceftriaxone
(PCN + gentamicin preferred)
What is the treatment for MRSA
Vancomycin or Daptomycin
What is the treatment for S. Aureus
Naficillin
Oxacillin
Cephazolin
PV: Add Rifampin or gentamicin
What is the treatment for HACEK organisms
Ceftriaxone
How long until you should see a response with treatment for IE
3-4 days
repeat blood cultures to monitor relapse
What complications can occur with IE
Cardiac Neurologic Septic emboli Metastatic infection Systemic immune reaction
What are indications for IE surgery
worsening CHF abscess fungal infection Staph on PV Abx failure 2 major emboli
What is prophylactic therapy for dental and respiratory procedures
Amoxicillin
Who should receive prophylactic treatment
Prosthetic cardiac valve
previous IE
CHD
Heart transplant with valvuloplasty
What cardiac conditions do NOT need prophylaxis
MVP, RHD, AS
What procedures require prophylaxis
dental procedure involving gingiva (including cleaning)
incision of respiratory mucosa (tonsillectomy)
procedure on infected skin
