Infective Endocarditis Fall 2012

Intravenous access ie intravascular devicecentral

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intravenous access (ie intravascular device/central venous catheter) IV drug abuse (IVDA) Long-term hemodialysis Poor dental hygeine
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Risk Factors: Prosthetic Valves Early prosthetic valve endocarditis (PVE) Occurs within 1 year of valve surgery Late PVE Occurs > 1 year of valve surgery
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Etiology Streptococci Staphylococci Enterococci Gram-negative bacilli HACEK organisms Fungi Most common
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Streptococci Responsible for 25-35% of IE cases Gram-positive cocci in pairs or chains Types Viridans strep ( S. mitis , S. sanguis, S. mutans, S. oralis, S. salivarus, S. intermedius, etc . ) Located in the mouth Other S. bovis In GI tract Associated with colon cancer Most common Native valve IE in patients with underlying cardiac abnormalities (e.g. mitral valve prolapse with regurgitation) Late PVE
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Staphylococci Responsible for 45-70% of IE cases Gram-positive cocci in clusters Types Coagulase-positive ( S. aureus ) Most common causative organism Up to 50% are methicillin-resistant S. aureus (MRSA) Coagulase-negative ( S. epidermis ) Up to 80% are methicillin-resistant (MRSE) Most common Early PVE (either S. aureus or S. epidermis ) IVDA: S. aureus is most common cause
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Enterococci Responsible for 5-18% of cases Gram-positive cocci in pairs or chains E. faecalis and E. faecium Common after procedures involving GI Genitourinary (older men) Obstetric procedures (younger women)
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Gram-positive Cocci Images: Streptococ ci Staphylococ ci
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Gram-negative Bacilli Responsible for 1.5-13% of cases Examples: Enterobacteriaceae ( E. coli ), Pseudomonas aeruginosa , Salmonella Risk factors IVDA ( P. aeruginosa ) Prosthetic valves Health-care contact High mortality (60-83%)
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Fungi 1-4% of IE cases Candida and Aspergillus spp Risk factors IVDA Extensive health-care contact Immunocompromised Central venous catheter
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Culture-Negative IE <5-25% of IE cases Clinical presentation consistent with IE but blood cultures are negative Can occur in: Previous antibiotic exposure Atypical organisms (e.g. Legionella , Chlamydia , Bartonella , and HACEK) Fungi
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HACEK Organisms <5-10% of IE cases HACEK Haemophilus spp Actinobacillus spp Cardiobacterium spp Eikenella spp Kingella spp Oropharyngeal organisms Often the cause of culture-negative IE Fastidious organisms (slow-growing)
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Clinical Presentation Nonspecific symptoms Fever (may be low-grade) Chills Weakness Dyspnea Night sweats Weight loss Malaise
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Clinical Presentation Signs Heart murmur (new or change) >85% of IE cases
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