Infective Endocarditis Flashcards
What is the recidivism, re-infection and re-operation rate for IDU-IE post surgery?
Osterdal et al. 2016 - 70% recidivism after 1st surgery, 44% after 2nd surgery
Kim et al. 2015 - 6.2 HR of re-infection of the valve compared to non-IDU IE
IDU-IE have between 2-4 times greater risk of re-operation compared to non IDU-IE and the risk is highest in the 90-180 days after the operation (10x)
What is the 1, 5, 10 year survival for IDU-IE and non-IDU IE post surgery?
Goodman-Meza et al. 2019 - Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID
Kim et al. 2015 - In this study overall 5- and 10-year survival rates were 78.9% ± 6.0% and 69.5% ± 8.3% in IVDUs, respectively; and 76.1% ± 2.6% and 68.7% ± 3.9% in non-IVDUs, respectively
What is the most commonly affected valve in IDU-IE?
Tricuspid valve
<p>Dukes criteria: Major</p>
<p>Dukes criteria: Minor</p>
<p>Early surgery (native valve IE).Early valve surgery is recommended, or should be considered, for native left-sided IE in the following scenarios:</p>
<ol>
<li>Valve dysfunction resulting in symptoms or signs of heart failure.</li>
<li>IE caused by fungi or highly resistant organisms.</li>
<li>IE complicated by heart block, annular abscess, or destructive perforating lesions.</li>
<li>Persistent infection (bacteremia or fever) lasting >5-7 days after the start of appropriate antimicrobial therapy, assuming other sources of infection or fever have been excluded.</li>
<li>Recurrent emboli or persistent/enlarging vegetations despite appropriate antimicrobial therapy.</li>
</ol>
<p>Early surgery (prosthetic valve IE).Early valve surgery is recommended, or should be considered, for prosthetic vale IE in the following scenarios:</p>
<ol>
<li>Symptoms or signs of heart failure resulting from valve dehiscence, intracardiac fistula, or severe prosthetic dysfunction.</li>
<li>Persistent bacteremia >5-7 days after the start of appropriate antimicrobial therapy.</li>
<li>Prosthetic valve IE complicated by heart block, annular abscess, or destructive perforating lesions.</li>
<li>Prosthetic valve IE caused by fungi or highly resistant organisms.</li>
<li>Recurrent emboli despite appropriate antimicrobial therapy.</li>
</ol>
<p>High-risk procedures in which high-risk patients should receive antibiotic prophylaxis.</p>
Incidence of prosthetic valve endocarditis (PVE)
0.5-1% per year post op
Most common organisms implicated on early PVE (6-12 months post op)
a. Staph epi
b. staph aureus
c. strep viridans
d. gram neg rods
e. fungi
Indications for immediate reop
- Periprosthetic leak
- Conduction abnormality
- annular abscess
- intracardiac fistula
Of note, it is acceptable to treat patients with only leaflet vegetationswith 6 weeks of intravenous antibiotics in an attempt to eradicate the infection and to sterilize the surgical field.
Most common bacteria that cause Native valve infective endocarditis (NVE)
Strep viridans (28%)
Initial treatment for Native valve infective endocarditis
IV penicillin + gentamicin (6 weeks)
Indication for surgery for Native valve endocarditis
a. Peri-annular abscess
b. heart block
c. fungal infection
d. vegetation > 10 mm (any dimension)
e. persistently positive blood cultures
f. recurrent embolization despite treatment
g. congestive heart failure
Which valve should be used for IVDU endocarditis?
Bioprosthetic valve
