Intern Morning Report 8/11/15 – Endocarditis Review

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

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