We went over a fascinating case of MSSA endocarditis in the setting of immunosuppression. Below are some of the clinical pearls:

1. Modified Duke Criteria for infective endocarditis

• Major criteria
  • Positive blood cultures
    • Typical microorganism from two separate blood culture
    • Single positive blood culture for Coxiella burnetii
    • Persistently positive blood cultures
  • Echocardiogram findings of vegetation
  • New valvular regurgitation
• Minor criteria
  • Predisposing heart condition or IVDU
  • Fever >38C
  • Vascular phenomena
    • Major arterial emboli
    • Septic pulmonary infarcts,
    • Mycotic aneurysm
    • intracranial hemorrhage
    • conjunctival hemorrhages
    • Janeway Lesions
  • Immunologic phenomena
    • glomerulonephritis
    • Osler nodes
    • Roth spots
    • Rheumatoid factor
• Clinical Diagnosis
  • 2 Major criteria OR
  • 1 major and 3 minor criteria OR
  • 5 minor criteria

2. Surgical Indications for treatment of endocarditis:

• Valve dysfunction causing heart failure
• Para-valvular involvement causing abscess, fistula or heart block
• Difficult to treat organisms (fungal)
• Persistent bacteremia
• Recurrent septic emboli with vegetations despite appropriate antibiotic therapy

3. Most common bacteria associated with endocarditis

• Viridans streptococci
• Staphylococcus (MRSA or MSSA)
• Enterococci