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AIP: Sepsis > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What is the strongest risk factor for developing infective endocarditis?

A

previous episode of endocarditis

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2
Q

What are 6 types of patients who are affected by infective endocarditis?

A
  1. Previously normal valves
  2. Rheumatic valve disease
  3. Prosthetic valves
  4. Congenital heart defects
  5. Intravenous drug users
  6. Recent piercings
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3
Q

Which valve is most commonly affected by infective endocarditis in previously normal valves?

A

mitral valve

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4
Q

What valve is most commonly affected by infective endocarditis in IVDU?

A

tricuspid

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5
Q

What is now the most common cause of infective endocarditis?

A

Staph aureus

(previously Streptococcus viridans)

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6
Q

In which 2 types of presentations of infective endocarditis is Staph aureus commonly the cause?

A
  1. Acute presentation
  2. IVDUs
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7
Q

What type of bacteria commonly colonise indwelling lines?

A

coagulase negative Staphylococci e.g. Staphylococcus epidermidis

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8
Q

What is the most common cause of infective endocarditis following prosthetic valve surgery?

A

Staphylococcus epidermidis - usually due to perioperative contamination

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9
Q

What proportion of cases of infective endocarditis is now accounted for by Streptococcus viridans?

A

20% of cases

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10
Q

What are the 2 most notable forms of viridans streptococci?

A
  1. Streptococcus mitis
  2. Streptococcus sanguinis
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11
Q

What type of cause of infective endocarditis is linked with Streptococcus viridans?

A

poor dental hygiene or following a dental procedure (as commonly found in mouth and in dental plaque)

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12
Q

Which type of infective endocarditis is associated with colorectal cancer?

A

Streptococcus bovis

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13
Q

What subtype of streptococcus bovis is most linked with colorectal cancer?

A

Streptococcus gallolyticus

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14
Q

What are 2 non-infective causes of infective endocarditis?

A
  1. Systemic lupus erythematosus (Libman-Sacks)
  2. Malignancy: marantic endocarditis
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15
Q

What are 5 culture negative causes of infective endocarditis?

A
  1. Prior antibiotic therapy
  2. Coxiella burnetii
  3. Bartonella
  4. Brucella
  5. HACEK: Haemphilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
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16
Q

What is the name of the criteria to help diagnosed infective endocarditis?

A

Modified Duke Criteria

17
Q

What are the 4 broad components of the Modified Duke criteria?

A

Infective endocarditis diagnosed if:

  • pathological criteria positive OR
  • 2 major criteria OR
  • 1 major and 3 minor criteria OR
  • 5 minor criteria
18
Q

What are the pathological criteria for infective endocarditis?

A

Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery (valve tissue, vegetations, embolic fragments or intracardiac abscess content)

19
Q

What are 6 of the major criteria that are part of the Modified Duke criteria for diagnosing infective endocarditis?

A

Positive blood cultures:

  1. Two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group
  2. Persistent bacteraemia fom 2 blood cultures taken >12h apart or 3 or more positive blood cultures where the pathogen is less specific such as Staph aureus and Staph epidermidis
  3. Positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci
  4. Positive molecular assays for specific gene targets

Evidence of endocardial involvement:

  1. Positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves)
  2. New valvular regurgitation
20
Q

What are the 5 minor criteria that are part of the Modified Duke criteria?

A
  1. Predisposing heart condition or IVDU
  2. Microbiological evidence does not meet major criteria
  3. Fever >38
  4. Vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
  5. Immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots(eyes)
21
Q

What are 4 poor prognostic factors in infective endocarditis?

A
  1. Staphylococcus aureus infection
  2. Prosthetic valve (especially ‘early’, acquired during surgery)
  3. Culture negative endocarditis
  4. Low complement levels
22
Q

Which type of microorganism causing IE has the highest mortality?

A

staphylococci

23
Q

What is the suggested antibiotic therapy for a native valve affected by endocarditis when the causative organism is unknown?

A

amoxicillin, consider adding low dose gentamicin

if penicillin allergic, MRSA+ve or severe sepsis: vancomycin + low dose gentamicin

24
Q

What is the suggested antibiotic therapy for prosthetic valve infective endocarditis when the organism is not known?

A

vancomycin + rifampicin + low dose gentamicin

25
Q

What is the antibiotic management of prosthetic valve endocarditis caused by staphylococci?

A

flucloxacillin + rifampicin + low-dose gentamicin

if penicillin allergic or MRSA+ve: vancomycin + rifampicin + low-dose gentamicin

26
Q

What is the antibiotic management of native valve endocarditis caused by staphylococci?

A

flucloxacillin

if penicillin allergic or MRSA: vancomycin + rifampicin

27
Q

What is the antibiotic management for endocarditis caused by fully-sensitive streptococci e.g. viridans?

A

Benzylpenicillin

if penicillin allergic: vancomycin + low dose gentamicin

28
Q

What is the antibiotic management for endocarditis caused by less sensitive streptococci?

A

benzylpenicillin + low-dose gentamicin

if penicillin allergic: vancomycin + low-dose gentamicin

29
Q

What are 5 indications for surgery in infective endocarditis?

A
  1. Severe valvular incompetence
  2. Aortic abscess (often indicated by a lenghtening PR interval)
  3. Infections resistant to antibiotics/ fungal infections
  4. Cardiac failure refractory to standard medical treatment
  5. Recurrent emboli after antibiotic therapy
30
Q

What can often indicate an aortic abscess on ECG in infective endocarditis?

A

often indicated by a lenghtening PR interval

31
Q

What are 4 procedures for which IE prophylaxis was previously recommended but is no longer?

A
  1. Dental procedures
  2. Upper and lower GI tract procedures
  3. Genito-urinary tract: urological, gynaecological and obstetric procedures and childbirth
  4. Upper and lower respiratory tract: includes ENT procedures, bronchoscopy
32
Q

What are 2 forms of infective endocarditis prophylaxis that are still recommended?

A
  1. Episode of infection in patients at risk of IE should be investigated and treated promtpy to reduce risk of it developing
  2. If person at risk of IE is receiving antimicrobial therapy because they are undergoing GI or GU procedure at a site with suspected infection, shoudl be given antibiotic that covers IE
33
Q

Which 2 organisations do the NICE guidelines re IE prophylaxis contradict?

A

American Heart Association

European Society of Cardiology

AIP: Sepsis (11 decks)

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