Infective endocarditis risk factor Flashcards
(43 cards)
Who gets IE prophylaxis?
Unrepaired cyanotic (tetrallogy, truncus arteriosus, transposition, total anomalous venous return, pulmonary atresia, tircuspid atresia, Ebstein’s anomaly)
Repaired in last 6 months
Repaired but patch not endothelialised
prosthetic valve or valve material for repair
Indigenous RHD
Past history IE
What is the proph?
Oral amox for dental
IV amox
or if penacillin alergic
Clinda oral (dental)
Clinda IV
or Vanc IV
Which procedures not?
Minor dental Colonoscopy with biopsy local anaesthetic IDC bronch with or without biopsy as per etg vaginal delivery TOE GI or GU procedures with infection, where already covering enterococcus
If it’s culture negative, what is most likely?
Brucella Bartonella HACEK Coxiella burnetii Trophynema whipplei
HACEK= haemophilus, aggregatibacter actinomycetemcomitans, cardiobacterium hominis, eikinella, kingella
More likely to die if?
older s aureus healthcare associated cerebrovascular and embolic events heart failure
Most common symptoms?
Fever 80%
New or worsening murmur in 48/20 %
Haematuria in 25%
More likely to have a stroke/embolism if?
Mitral
Large
Staph
Blood cultures when?
Before the antibiotics
SErology for which organisms can be done if you get negaitive cultures?
bartonella
brucella
C burnetti
Roth spot how?
retinal haemorrhage with white/pale centre
Osler node how?
Immunologic origin
Tender
Janeway lesions how>?
non tender, small macular or nodular on palms/soles
VASCULAR mechanism
How long antibiotics if need a replacement during infection?
From the day of appropriate antibiotics, not from the day of surg
Do you use gent in staph endocarditis?
No in native
First two weeks in prosthetic
Indications for surgery?
Heart failure
Uncontrolled infection
Prevent embolic events
Fungal or pseudomonas
persisting fever and bacteraemia more than 7-10 days
very large vegetation- 30 mm or 10 after embolisation
Elevated LVEDP and pulm hypertension may substitute for clinical heart failure
Can you keep going with your aspirin during IE?
Yes you can. No evidence that reduces embolic events but is safe to take
How much endocarditis do you get post prosthetic valve>
1-4% per year first 4 years
then 1% per year
MECHANICAL JUST AS BAD AS PROSTHETIC
Are gut bugs a problem?
Only enterococcus
not really anaerobes or e coli
Immunologic in acute or chronic
more in chronic as have time to produce
Prosthetic valve endocarditis 1st 2 months?
staph epidermis (periop contamination)
after this spectrum returns to normal but slight increase in staph
Prosthetic after 18 months
same as native valve
Don’t forget can get pacemaker lead endocarditis!
causes a relapsing fever
Cannot cure medically
If old and not going to live long, long term antibiotics.
Otherwise need removal
IVDU with “pneumonia” what would you do?
Give staph coverage until blood cultures back
SBE organisms
ABE organism
ABE-staph
SBE-
1 Strep viridans (not actually a particular organism but many- mutans, bovis, mitis, sanguis, salivarus)
2. enterococcus faecalis
3. HACEK
4. uncommon but coag neg staph
5, bartonella, Q fever, brucella, legionella, tropheryma whipplei
