Infective Endocarditis Flashcards Preview

Infectious Disease > Infective Endocarditis > Flashcards

Flashcards in Infective Endocarditis Deck (17)
1

What are causes of abnormal endothelium?

Abnormal valves - rheumatic, congenital bicuspid aortic valve, degenerative (AS)
Prosthetic heart valves
Unrepaired congenital cyanotic heart diseases
Intracardiac device - PPM/ICD

2

Common organisms in native valve endocarditis

Viridans streptococci
Staph aureus
Strep bovis
Enterococci
HACEK

3

Common organisms in IVDU

Staph aureus - most common
Streptococci
Enterococci
Fungi + GNB - less common

4

Common source of bacteraemia

Oral flora - dental work
Bowel flora - underlying bowel disease
Skin flora - IVC, central access, skin surgeries
IVDU

5

Common organisms in prosthetic infections

Early infection (less than 2 months)
- staph aureus
- coag negative staph

Late infection
- same organisms as native valve IE

6

Vascular phenomenon seen in IE

Arterial embolism
- stroke, renal, splenic abscess/infarcts
Pulmonary infarcts
Intracranial haemorrhage
Mycotic aneurysm

7

Immunological phenomenon seen in IE

Glomerulonephritis
Oslers nodes
Roth spot
Rheumatoid factor

8

Dukes criteria

Definite: 2 major, 1 major + 3 minor or 5 minor

Major:
- positive blood culture from typical organism
- endocardial vegetations on ECHO

Minor:
- fever
- predisposition --> IVDU, predisposing heart condition
- vascular phenomenon
- immunological phenomenon
- suggestive microbiology

9

Complications of IE

Congestive heart failure
Embolisation - cerebral most common
Periannular extension of infection
Splenic abscess
Mycotic aneursym

10

Risk factors for death

Increased age
Staph aureus
Heart failure
Cerebrovascular and embolic events
Healthcare associated IE

11

Indications for surgery

Heart failure due to valvular regurgitation
Elevated LV end diastolic pressure or pul HTN
Heart block
Annular aortic abscess
Fistula
Mitral leaflet perforation
Fungal or resistant organism

12

Antibiotics for strep viridans IE

Penicillin and gentamicin
Also used in enterococcus but longer duration

13

Antibiotics for Staph aureus

Flucloxacillin
+ rifampicin and gentamicin if prosthetic valve

If MRSA - vancomycin

14

Antibiotics for culture negative IE

Ceftriaxone and gentamicin

15

Conditions for which antibiotic prophylaxis for IE is required

Prosthetic heart valve
Rheumatic valvular heart disease
Previous endocarditis
Unrepaired cyanotic congenital heart disease
Surgical repair of congenital heart disease within 6m

16

Procedures where prophylaxis for IE is indicated

Dental procedures and tonsillectomy
No longer recommended for anything else

17

Type of prophylaxis for IE

Oral amoxycillin 2g 1 hour prior