Infecive Endocarditis Flashcards
Risk factors for infective endocarditis?
- Previous episode of endocarditis
- Rheumatic valve disease
- prosthetic valves
- IVDU
- Congenital heart defects
- Dental devices
- Chronic inflammation (autoimmune)
- Immunocompromised
Which organisms cause infective endocarditis?
Staphylococcus aureus (IVDU), streptococcus viridans (dental procedures, developing countries), staphylococcus epidermis (prosthetic valves), streptococcus bovis (colorectal cancer)
Non infective causes of endocarditis?
SLE, malignancy
Culture negative causes?
Prior antibiotic therapy, coxiella burnetii, bartonella, brucella, HÁČEK haemophilus, actinobacillus, cardio bacterium, eikenella, kingella
Modified duke criteria?
Pathological criteria positive 2 major or 1 major 3minor or 5minor
Pathological criteria- histology/ culture valve tissue, vegetation’s, embolism fragments and intracardiac abscess content
Major criteria: 2 positive blood cultures showing typical organisms, persistent bacteriaemia from 2 cultures, evidence of positive echocardiogram endocardial involvement or new valvular regurgitation
Minor criteria- predisposing heart disease or ivdu, fever more than 38, vascular emboli: major emboli, splenomagaly clubbing splinter haemorrhages Jane way lesions petechia purpura, immunological phenomena: glomerulonephrits, oslers nodes Roth spots, positive blood culture but not typical agent
Poor prognostic factors?
Staph aureus
Prosthetic valve
Culture negative endocarditis
Low complement levels
Mortality according to organism?
Staphylococci- 30%
Bowel organisms- 15%
Streptococci- 5%
Indications for surgery?
Severe valvular incompetence, aortic abscess (lengthening pr interval), infections resistant to antibiotics, cardiac failure, recurrent emboli after antibiotic therapy
Blind therapy initially?
Native valve: amoxicillin, consider adding low dose gentamicin
If penicillin allergic or severe sepsis: vancomycin low dose gentamicin
If prosthetic valve= vancomycin rifampicin and low dose gentamycin
Native valve endocarditis cause by staphylococci?
Flucloxacilin, if penicillin allergic or MRSA, vancomycin and rifampicin
Prosthetic valve endocarditis cause by staphylococci?
Flucoxaciilin rifampicin and low dose gentamicin
If penicillin allergic: vancomycin, rifampicin and low dose gentamicin
Endocarditis by fully sensitive streptococci?
Benzylpenicillin, if allergic, vancomycin low dose gentamycin
Endocarditis caused by less sensitive streptococci?
Benzypenicillin and low dose gentamicin
If penicillin allergic: vancomycin and low dose gentamicin
Why does infective endocarditis happen?
Bacterial infection in blood plus endocardial insult (turbulent blood flow, solid particle, chronic inflammation and mechanical procedures)
Complications?
Valvular insufficiency *MS and aortic
Cardiac abscess, heart failure, MI
Stroke, cerebral abscess, mycotic aneurysm (aneurysm due to infection of vessel wall)
Renal infarction and glomerulonephritis
Spleen infarction and abscess PE
