OnlineMedEd: Infectious Disease - "Infective Endocarditis" Flashcards
Review the major and minor criteria for diagnosing infective endocarditis.
Major:
- Bacteremia with common endocarditis organisms (HACEK, Gram-positive cocci)
- New regurgitant murmur
- Echo showing vegetation
Minor:
- Risk factors (e.g., prosthetic valves, history of endocarditis, IV drugs)
- Fever ≥38º
- Vascular complications (embolism, splinter hemorrhages, Janeway lesions)
- Rheumatologic complications (Osler nodes, glomerulonephritis, Roth spots)
Review the signs of infective endocarditis based on the side of presentation.
Right-sided:
- Septic emboli in the lungs
Left-sided:
- Splinter hemorrhages
- Janeway lesions
- Osler nodes
- CVA 2/2 septic emboli
- Roth spots
- Glomerulonephritis
Discuss Dustyn’s method of categorizing infective endocarditis.
Acute vs. subacute
Acute:
- Virulent (super sick)
- Caused by Streptococcus, Staphylococcus
- Negative rheumatologic findings
Subacute:
- HACEK
- Less sick, fevers on-off
- Positive rheumatologic findings
How do you treat acute and subacute infective endocarditis?
Acute:
- Antibiotics until blood cultures are negative
Subacute:
- Blood cultures positive before antibiotics
True or false: get a TTE to diagnose infective endocarditis.
False
Get a TEE to look at the mitral valve.
Review the treatments for acute infective endocarditis.
- Native valve: vancomycin
- Artificial valve < 60 days: vancomycin and gentamicin
- Artificial valve 60 - 365 days: vancomycin, gentamicin, and cefepime
- Artificial valve older than 365 days: vancomycin, gentamicin, and ceftriaxone
Review the treatments for subacute infective endocarditis.
Gentamicin and ceftriaxone
In what cases is surgery indicated for infective endocarditis?
- Surgery
- > 15 mm vegetation
- > 10 mm with emboli
- Abscess
- Fungi
If you can’t use vancomycin, you should use _____________ to treat infective endocarditis.
daptomycin
