ICU · Cardiovascular

Infective endocarditis in the ICU

Also known as Infective endocarditis (IE) · Bacterial endocarditis · Subacute bacterial endocarditis (SBE) · Duke criteria · Valvular vegetation · Embolic phenomena · Native valve endocarditis · Prosthetic valve endocarditis

Infective endocarditis (IE) is microbial infection of the endocardial surface (usually heart valves). ICU admission for: septic shock, heart failure from valvular destruction, embolic stroke, conduction abnormalities. Diagnosis: modified Duke criteria (blood cultures + echocardiography). Organisms: S. aureus (1 overall — acute, aggressive), viridans streptococci (subacute — dental source, 1 in community-acquired native valve), Enterococcus (genitourinary source), HACEK, culture-negative (Coxiella, Bartonella, fungi — Candida), fungi (Candida — large vegetations, IVDU/prolonged lines). Treatment: prolonged IV antibiotics (4-6 weeks), organism-specific. Empiric: vancomycin + gentamicin + cefepime for severe/septic shock; definitive — penicillin/ceftriaxone for strep, nafcillin/oxacillin (flucloxacillin) for MSSA, vancomycin for MRSA. Surgery indications: heart failure from valvular destruction (1), uncontrolled infection, large mobile vegetation with embolism, perivalvular extension (abscess), prosthetic valve dehiscence.