Infective endocarditis Flashcards Preview

Internal Medicine > Infective endocarditis > Flashcards

Flashcards in Infective endocarditis Deck (13):
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

Recommendations for followup

1. Before completing antimicrobial therapy, patients should receive transthoracic echocardiogram (TTE) to establish a new baseline.
2. In addition, it is generally recommended that patients with prosthetic valve endocarditis undergo trans-oesophageal echocardiogram (TOE) at the completion of therapy.
3. All patients should have blood cultures done at 1 and 2 weeks following therapy to ensure they are not persistently bacteraemic.
4. Patients with risk factors such as intravenous drug use should be referred promptly to a cessation programme. I
5. n addition, all patients should be educated regarding the signs and symptoms of IE, as, if there is a recurrence, early treatment may prevent long-term complications.