infective endocarditis Flashcards
(22 cards)
commonest valve affected in infective endocarditis
mitral valve
risk factors for infective endocarditis
- previous episode of endocarditisi = strongest RF
- rheumatic valve disese
- prosthetic valves
- congenital heart defects
- IV drug users
- recent piercings
which valve is most commonly affected in IV drug users with infective endocarditis
tricuspid !
commonest causative organism of infective endocarditis
staphylococcus aureus
- esp in IV drug users
which patient is strep viridans most likely to be the causative organism
poor dental hygiene or following dental procedure
(found in mouth + dental plaque)
e.g. steptococcus sanguinis (if grown -> require dental review)
commonest causative organism of infective endocarditis after prosthetic valve replacement
staph epidermidis (coag-neg staph)
- usuallyresult of perioperative contamination
after 2 months the causative organism returns to normal (i.e. staph aureus most common cause
commonest causative organism of infective endocarditis in those with colorectal cancer
streptococcus bovis
criteria for infective endocarditis
modified Duke criteria
diagnosed if;
- pathological criteria positive or
- 2 major criteria or
- 1 major + 3 minot criteria or
- 5 minor criteria
major criteria of modified Duke criteria
positive blood cultures
evidence of cardiac involvement
- positive echo
- new valvular regurg
extra cardia features of infective endocarditis
splinter haemorrhages
petechiae - small, non-blanching red/brown spots
janeway lesions
oslers nodes
roth spots - eyes
in longstanding disease -
- splenomegaly
- finger clubbing
what are janeway lesions, osleers nodes and roth spots
janeway lesions = painless red flat macules on the palms of the hands + soles of the feet
Osler’s nodes = tender red/purple nodules on the pads of the fingers + toes
Roth spots = haemorrhages on retina seen on fundoscopy
minor criteria in dukes
- predisposing heart condition or IV drug use
- fever >38C
- vascular - major emboli, petechiae etc
- immunological - glomerulonephritis, oslers nodes, roth spots
blood cultures for infective endocarditis
done BEFORE starting antibiotics
3 samples taken
- separated by at least 6hrs
- taken from different sites
poor prognosis factors in infective endocarditis
staph aureus infection (30% mortality)
prosthetic valve - esp if acquired early/during surg
culture negative endocarditis
low competent levels
antibiotics given for infective endocarditis in initial blind therapy
native valve
- amoxicillin, consider adding low-dose gentamicin
- pen allerg = vancomycin + low-dose gent
prosthetic valve
- vancomycin + low-dose gent + rifampicin
antibiotics given for infective endocarditis if native valve endocarditis caused by staphylococci
flucloxacillin !
pen allergic/MRSA = vancomycin + rifampicin
antibiotics given for infective endocarditis if prosthetic valve endocarditis caused by staphylococci
flucloxacillin + rifampicon + low-dose gentamicin
if pen all = vancomycin + low dose gent + rifampicin
antibiotics given for infective endocarditis if endocarditis caused by fully-sensitive streptococci (e.g viridans)
benzypenicillin
pen all = vancomycin + lowdose gent
antibiotics given for infective endocarditis if endocarditis caused by less sensitive streptococci
benzylpenicillin + low-dose gentamicin
pen all = vancomycin + low-dose gent
indications for surgery for infective endocarditis
- severe valvular incompetence
- aortic abscess (lengthening PR interval)
- infections resistant to abx/fungal infections
- cardiac failure - refractory to tx, congestive (oedema) HF
- recurrent emboli after antibiotic therapy
infective endocarditis prophylaxis
no, dont do it
