Endocarditis Flashcards
What valve is MC infected?
-The exception is in IVDU. In this case, what valve is the MC infected?
Mitral overall
Tricuspid if IVDU
Acute Bacterial Endocarditis (infection of normal valve)
-MC organism
-Staph Aureus
–Also common in IVDU
Subacute (infection of abnormal valve)
-MC organism
-What is also associated with
-Strep Viridans
-Associated with poor dentition or dental procedures
IVDU-related MC organism involved
Staph Aureus (especially MRSA)
Prosthetic valve endocarditis
-Early (within 60 days) MC organism
-Late (after 60 days) MC organism
-Early: Staph epidermis
-Late: Staph Aureus
What organism causes endocarditis that is seen especially in men > 50 with a recent history of GI or GU procedure?
Enterococcus
What is the modified Duke Criteria, what do you need to diagnose as endocarditis, and what are the components of each category?
-You need 2 major OR 1 major + 2 minor
-MAJOR
–2 positive blood cultures by known organism
–Endocardial involvement (either + echo or new valvular regurgitation)
-MINOR
–Fever
–Predisposing condition (IVDU, abnormal valves, indwelling catheters)
–Vascular phenomena: Janeway lesions, pulmonary emboli
–Immunologic phenomena: Osler nodes, Roth spots, + Rheumatoid Factor, acute glomerulonephritis
– + blood culture with diff organism
– + echo not meeting major criteria (worsening murmur for example)
What are the common symptoms of endocarditis?
-Persistent fever (MC)
-New onset murmur or worsening or an existing murmur
-Roth spots: retinal hemorrhages with central clearing
-Osler nodes: painful nodules on pads of digits and palms
-Janeway lesions: painless macules on palms and soles
-Splinter hemorrhages: linear lesions under nail bed
-Splenomegaly
-Glomerulonephritis
How long do you treat a patient with ABX who has endocarditis?
4-6 weeks
Native Valve Treatment:
Prosthetic Valve Treatment:
Fungal Treatment:
-Nafcillin/Oxacillin + Ceftriaxone/Gentamicin
(Vanco if PCN allergic)
-Vanco + Gentamicin + Rifampin
-Amphotericin B (6-8 weeks)
What diagnostic studies should you be obtaining in a patient you suspect endocarditis?
-Blood cultures: 3 sets at least 1 hour apart
-ECG at regular intervals
-Transesophageal echocardiogram (TEE)
Name some patients who should get endocarditis prophylaxis and what procedures need it.
-Cardiac conditions: prosthetic heart valves, heart repairs (not including stents), prior history of endocarditis, congenital heart disease
-Procedures: Dental, Respiratory, Skin/MSK tissues (abscess drainage, etc.)
What are some options for prophylaxis for endocarditis?
Amoxicillin 2g 30-60 minutes prior to procedure
Clindamycin 600mg if PCN allergic
What type of endocarditis is associated with systemic lupus erythematosus (SLE)?
What is this?
Libman-Sacks Endocarditis
-Nonbacterial thrombotic endocarditis due to sterile platelet thrombi deposition on affected valve