Definition
Infective endocarditis is an infection of the endocardium that typically affects one or more heart valves.
- Acute vs subacute:
- Acute
- Fast progression (days – weeks)
- High fever
- S. Aureus
- Subacute
- Slow progression (weeks – months)
- Low fever
- Viridans strep, Enterococci, S. Aureus
- Acute
- Most common pathogens:
- S. Aureus
- Viridans group streptococci
- enterococci
- Risk factors:
- > 60 years of age
- Male
- IV drug use
- Poor dentition
- Valve involvement order:
- Mitral
- Aortic
- Tricuspid
- Pulmonary
- Duke Criteria (Presence of 2 major OR 1 major with 3 minors OR 5 minors)
- Major
- 2 separate blood cultures (S. Aureus, HACEK, S. Viridans)
- One positive culture from Coxiella Burnetii
- Echocardiographic findings of IE
- Minor
- Predisposing condition
- Fever (>38C)
- Vascular abnormalities (emboli, septic infarctions, Janeway lesions)
- Immunologic abnormality (glomerulonephritis, Osler’s nodes, roths sports, positive rheumatoid factor)
- Microbiological evidence (+ve blood culture not meeting major criteria)
- Major
- CXR: cardiomegaly
- Echocardiogram (best): inflamed heart muscle, dilation
- ECG: Sinus Tachycardia, T-wave inversions, ST elevations
- FBE
- Elevated Troponin
- Elevated Creatine Kinase
- Antibiotics
- Vancomycin with:
- Cefepime for native acute cases
- Ampicillin-sulbactam for native subacute cases
- Vancomycin with:
- Transplant in severe cases