Infective Endocarditis (quick review)

31 May

RAGING HYPOTHETICAL:

your next patient is a 67 year old man with a fever.  previous blood cultures grew out pseudomonas on a recent admission, there’s a nice diastolic murmur, and a CT Chest shows emphysematous changes and one cavitary lesion concerning for hematologic seeding infection.  Can you officially diagnose this as….endocarditis?

 

Duke Clinical Criteria for the Diagnosis of Infective Endocarditis:

(2 major, 1 major and 3 minor, or 5 minor)

Major Criteria:

 • Typical microorganism (Strep Bovis, HACEK group, Staph Aureus, Staph Enterococci) consistent with IE from 2 separate blood cultures

• Microorganism consistent with IE from persistent positive cultures

    •  (2 positive >12 hours apart or all 3 or 3 of 4 drawn 1 hour apart)

Minor Criteria:

• Predisposition: predisposing heart condition or IV drug use

• Fever: temp > 38.0

• Vascular Phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, and Janeway lesions

• Immunologic Phenomena: glomerulonephritis, Osler’s nodes, Roth spots, and rheumatic fever

• Microbiological Evidence: positive blood cultures not meeting major criteria

• Echocardiographic findings: consistent with IE but not meeting major criteria

 

Indications for Surgery:

• Heart Failure

• Uncontrolled Infection

• Prevention of Embolism

 

Key Points:

• Staph and strep account for a majority of IE cases

• Cerebral complications are the most frequent and most severe extracardiac complications.

• Antibiotics should be held if clinically possible until blood cultures are collected

• ECHO should be performed as soon as possible when IE is suspected

• Indications for surgery include heart failure, uncontrolled infection, and prevention of embolic events.

• Treatment should involve a multidisciplinary team with expertise in cardiology, cardiac surgery, and infectious disease.

• Indications for antibiotic prophylaxis have been restricted to invasive dental procedures in select patients

 

Submitted by K. Dabrowski.

 

References:  Hoen, Bruno, M.D, Ph.D, and Xavier Duval, M.D., Ph.D. “Infective Endocarditis.” N Engl J Med 368: 1425-33.; picture

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: