Infective Endocarditis

High risk patients:

  • Prosthetic valves
  • High flow heart diseases -> any stenotic valvular lesions, MVP + regurg, PDA (septal defects are not high flow)
  • AV fistula
  • Indwelling Rt heart cath
  • Marfan syndrome

 

Organisms:

  • Native valves (in CHD): viridans
  • Prosthetic valves: epidermidis, S. viridans, S. aureusEndocarditis 3
  • IV drug users: aureus, S. epidermidis
  • Rarely; enterococci or gram neg (HACEK)

 

Types:Endocarditis 2

 

Duke’s criteria:

2 major   OR   1 major + 3 minor   OR   5 minorEndocarditis 1

 

Management:

  • If septic: fluids + pressors (nor-\epinephrine, dopamine)
  • Take cultures before initiating abx
  • Best first step in dx? Echo
  • Do surveillance blood cultures to monitor therapy

 

Empiric antibiotics:

(combination therapy + IV + usually 6 wks)

  • S. viridans:
    • Penicillin\amoxicillin\ceftriaxone + gentamicin
    • If allergic -> vancomycin + gentamicin
  • S. aureus:
    • Oxacillin\flucloxacillin\nafcillin + gentamicin
    • If allergic -> vancomycin + gentamicin
    • If prosthetic valve -> add Rifampin to the above regimen

 

Endocarditis prophylaxis: 

  • Who?
    • Prosthetic valve
    • Previous IE
    • Unrepaired cyanotic CHD
  • When?
    • Only before dental procedures involving manipulation of the gingiva or perforation of the oral mucosa
    • Tonsillectomy \ adenoidectomy
    • Not recommended for GI, resp, skin procedures!
  • How? (30-60 min before procedure)
    • Amoxicillin (2gm)
    • If allergic -> clindamycin (600mg)

 

Indications for surgery: 

  • Refractory CHF
  • Persistent sepsis
  • Recurrent peripheral emboli
  • Perivalvular complication (dehiscence, obstruction, leak)

 

 


Download the PDF version: here


References:

  • Dr. Alghamdi’s lecture
  • Kaplan step 2 lecture notes
  • Paul Bolin’s video

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