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updated endocarditis powerpoint

updated endocarditis powerpoint - INFECTIVE ENDOCARDITIS...

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Unformatted text preview: INFECTIVE ENDOCARDITIS Shehla P.Islam, M.D. Division of Infectious Diseases University of Florida Novemeber 3, 2010 Outline • Epidemiology • Pathogenesis & Antibiotic prophylaxis • Clinical Manifestations • Diagnosis (TEE & Modified Duke Criteria) • Complications • Treatment (emphasis on early surgery) Case • At midnight on July 2, your first night on call as an intern, you’ve just admitted 5 patients and are cross- covering for your co-intern. You got a call from the micro lab. One of the patients your colleague admitted earlier that day, one set of the blood cultures is positive, growing gram positive cocci. • The patient is a 40 y.o. female with a history of asthma. One day PTA, she was seen in the ER with several days of low grade fevers, and the initial work up was unrevealing. Blood cultures were drawn and she was sent home. She came back with persistent low grade fevers, and now has pleuritic chest pain and some shortness of breath. Q1 • What would you do at this time? 1. This is bacterial endocarditis; I’d start her on vancomycin STAT 2. draw one more set of blood cultures to be sure, and start her on vancomycin 3. draw 2 more sets of blood cultures, and start her on vancomycin 4. could be a contaminant; I’d draw 2 more sets of blood cultures and hold off on abx 5. it’s probably a contaminant (coag negative staph); hold off on abx, order tylenol STAT, and go back to bed Outline • Epidemiology • Pathogenesis & Antibiotic prophylaxis • Clinical Manifestations • Diagnosis (TEE & Modified Duke Criteria) • Complications • Treatment (emphasis on early surgery) Which group has the highest incidence of endocarditis? 1. Children ages 1-10 y 2. Women age 20-50 3. Men age 20-50 4. Women over age 50 5. Men over age 50 Epidemiology • >50% of case over age 50 • male:female 1.7:1 • Aortic valve and Mitral valve most common (age dependent) Tricuspid rarer (iv drug abusers) Pulmonary valve exceedingly rare Etiologic Agent in IE ■ Streptococci 60-80% Viridans Streptococci 30-40% Enterococci 5-18% Other Streptococci 15-25% ■ Staphylococci 20-35% Coagulase + 10-27% Coagulase - 1-3% ■ Gram Negative aeorobic 1.5-13% ■ Fungi 2- 4% ■ Culture Negative <5-24% HACEK ■ Fastidious organisms, slow growing Hold blood cultures x 4 wks, Subculture on chocolate agar, 5%CO2 ■ Haemophilus aphrophilus ■ Actinobaccillus actinomycetemcomitans ■ Cardiobacterium hominus ■ Eikenella ■ Kingella ■ An Additional cause of Culture Neg Tropheryma whippelii HACEK ■ Fastidious organisms, slow growing...
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updated endocarditis powerpoint - INFECTIVE ENDOCARDITIS...

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