Flashcards in Infective endocarditis Deck (13)
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1
Definition
Infection of endocardial surface of the heart
Acute= days to weeks
Subacute= weeks to months->vague constitutional
2
Etiology
Viridans group Strep
S. Aureus->catheter, IVDU
Enterococci->previous GU surgery/instrumentation
Coagulase negative Staph->neonates, prosthetic
Fungi
Coxiella burneti
S bovis->elderly, adenoC of bowel
HACEK in culture negative
3
Pathophysiology
Infection on valve which have sustained endothelial injury
Platelets and fibrin adhere to collagen, prothrombotic mileui
Bacteremia leads to colonisation of thrombus, further deposition= mature infected vegetation
4
Presentation in native valve
Non IVDU: viridans, enterococci, staph
IVDU: Staph, strep, gram negative. Associated with right sided
5
Presentation in prosthetic
Early: Staph and coagulase negative
Late: Strep, enterococci, staph
6
High risk population
History of previous
Prosthetic
CHD
Cardiac transplant
Denta
Invasive of respiratory, infected skin, MSK
7
Clinical features
fever/chills (common)
night sweats, malaise, fatigue, anorexia, weight loss, myalgias (common)
weakness (common)
arthralgias (common)
headache (common)
shortness of breath (common)
meningeal signs (uncommon)
cardiac murmur (uncommon)
Janeway lesions (uncommon)
Osler nodes (uncommon)
Roth spots (uncommon)
8
Investigations
FBC->anaemia, leukocytosis
UEC, glucose->N/ +urea
Urinalysis->RBC casts, WBC casts, protein+, pyuria
BC
ECG->prolonged PR, non-specific ST changes
EchoC->mobil, valvular lesions
9
Duke criteria
2 major or 1 major and 3 minor or 5 minor
1. Major:
+BC->typical organism from 2 separate BC, persistently +ve BC
Evidence of endoC involvement->evidence of mass on echo, abscess, new regurgtation murmur
2. Minor:
Predisposing heart/IVDU
Fever >38
Vascular->major arterial emboli, septic pulmonary infarcts, myoctic aneurysm, conjunctival hemorrhage, JWL
Immunological: GN, Osler nodes, Roth spots, RF
Microbiological->+ve not meeting major
Echo->Consistent, not meeting major
10
Management
ABC
Oxygen
2 large IV cannula, catheter if required
Manage decompensated HF if required
BC, FBC, urinalysis, glucose
Call cardiology, ID, surgery
Start antibiotics, fluids
Admit
Arrange Echo
Repeat BC
Regular monitoring
Considerations for surgery
11
Antibiotic regime
Native valve empirical: benpen (Vanc if suspect MRSA) + gentamicin + flucloxacillin
If hypersensitive to penicillin-> gent + vanc + cefazolin
Prosthetic/PaceM: Vanc + fluclox + gent
12
Indications for surgical management
Intractable congestive heart failure caused by valve dysfunction >1 serious systemic
embolic episode, or large (>10 mm) vegetation with high risk for embolism
Uncontrolled infection, eg, positive cultures after 7 d of therapy
No effective antimicrobial therapy (eg, fungal endocarditis)
Most cases of prosthetic valve endocarditis, especially S aureus prosthetic valve infection
Local suppurative complications, eg, myocardial abscess
13
