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What are HACEK organisms

A group of gram negative fastidious bacilli that require prolonged culture in 10% CO2
Haemophilus species (not influenza)
Cardiobacterium hominis
Eikenella corrodens


What are commonest organisms in patients with native valve infective endocarditis

Streptococcus (45%) Viridans (including milleri, oralis, mitis, mutans, salivarius) or bovis
Staphylococcus aureus or epidermidis (35%)
Enterococcus Faecalis (10%)
Diptheroid bacillis and micro-aerophilic streptococci
Anaerobic gram negative bacilli
Listeria, Bacteroides, fusobacterium, Legionella, Propionibacterium acnes, brucella abortus
Coxiella Burnetii (Q fever)
Chlamydia psittaci or trachomatis


What are commonest organisms in patients with prosthetic valve infective endocarditis < 2months

Staphylococcus aureus and epidermidis (45-50%)
Gram negative bacilli
Streptococcus and Entercoccus (<10%)


What are commonest organsims of prosthetic IE > 2months

Streptococcus viridans (45%)
Staphyloccus aureus and epidermidis (35%)
Enterococcus faecalis (10%)


What are causes of non-infective endocarditis

Anti-phospholipid syndrome (Hughes syndrome)
Acute rheumatic fever (Lancefield group A Streptococcus)
Libman-sacks endocarditis (SLE and scleroderma)
Mucinous adenocarcinoma (pancrease, lung, GI tract)
Other malignant disease--lymphoma, bladder CA


What are Dukes Minor criteria

Predisposing factors (IV drug use, cardiac lesion)
Fever > 38 degree C
Embolic or vascular phenomena
Immunological phenomena
Serology consistent with IE
Blood cultures compatable but not typical of IE


What are major criteria for Dukes Classification

1) Three positive Blood cultures (12 hours apart)
showing typical organisms (Strep bovis or viridans, Staph aureus, entercocci, or HACEK
2) Evidence of endocardial infection
vegetation, abscess, prosthetic valve dehiscence , new regurgitation


What is significance of Dukes Criteria

Definite endocarditis (Specificity 99% and sensitivity 80%)

Clinical diagnosis
1) 2 major criteria
2) 1 major and 3 minor criteria
3) five minor criteria
4) pathological diganosis by histological evidence of active infective endocarditis (post op specimen).


Graft selection for aortic root replacement in complex active endocarditis

UPenn from 2000 to 2010 in 134 patients

32.1 +/- 29.4 months follow up and showed 5 year survival rates betweem mechanical, bioprosthetic, and homograft of similar results (58% each)


What is rate of prosthetic valve endocarditis

0.5 to 1% per year following valve surgery


What valve are most likely to be infected

Left sided valves (mitral is more common then aortic)
5% involving the tricuspid and very rare for pulmonary


What is brief pathophysiology of infective endocarditis

platelet-fibrin thrombus formation with subsequent bacterial colonisation resulting in vegetation formation and spread into the surronding tissues


What is Roth spot

Retinal boat-shaped hemoorage with a pale center


What are splinter hemorrhages

thin reddish-brown lines in the nail bed


What are Osler's nodes

painful pulp infarcts on fingers, toes, palms or soles


What are Janeway lesions

painless flat palmar and plantar erythema


What are most common organisms in early PVIE

Staph aureus and Stah epi (50%)
Gram negative
Strep and Enterococcus (< 10%)


What antibiotics should be used for the common organisms in IE

Penicillin and gentamicin can be started
if you suspect stap then you need to start vanco
If enterococcus start amoxycillin and gentamicin


What is suggested treatment for HACEK

Start ceftriaxone
usually beta-lactam resistant


What are causes of non-infective (marantic) IE

musconous adenocarciumoa (pancreas, lung, upper GI tract)
other malignant disease --lymphoma, bladder carcinomoa
Anti-phospodlipid syndrome (hughes syndrome)
Acute rheumatic fever (GAP strep)
Libman-sacks endocarditis (SLE)


What is significance of Dukes Criteria

Specificitiy 99%
Sensitivity 80%


What are empiric antiobiotic treatments for acute IE

Empiric antibiotic therapy is chosen based on the most likely infecting organisms.

Native valve endocarditis (NVE) has often been treated with penicillin G and gentamicin for synergistic coverage of streptococci.


List coverage for IV drug users

Have been treated with nafcillin and gentamicin to cover for methicillin-sensitive staphylococci.

emergence of methicillin-resistant S aureus (MRSA) and penicillin-resistant streptococci has led to a change in empiric treatment with liberal substitution of vancomycin in lieu of a penicillin antibiotic


What is treatment regimen for prosthetic IE

Prosthetic valve endocarditis (PVE) may be caused by MRSA or coagulase-negative staphylococci (CoNS)
thus, vancomycin and gentamicin may be used for treatment, despite the risk of renal insufficiency.
Rifampin is necessary in treating individuals with infection of prosthetic valves or other foreign bodies because it can penetrate the biofilm of most of the pathogens that infect these devices.


What is dose of pen g

Endocarditis: 12-20 million units/day IV divided q4-6hr x4-6 weeks


What are rates of recurrence post IE

“Recurrence rates are approximately 5% to 12%.”


What are clinical features of infective endocarditis

Clinical features of infection: fever, night sweats, rigors, weight loss, malaise,
Immune complex depositions are:
Roth spots--retinal boat shaped hemorrhage with a pale center
Splinter hemorrhages--thin reddish-brown lines in the nail bed
Oslers Nodes---painful pulp infarcts on the fingers, toes, palms and soles
Janeway lesions--painless flat palmar or plantar erythema
vassulitis (brain, skin, kidney) and arthalgia
clinical features of cardiac lesion
clinical features of emboli

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