Phys · cardiovascular
Infective Endocarditis
Also known as IE · bacterial endocarditis · subacute bacterial endocarditis · SBE · acute bacterial endocarditis · native valve endocarditis · prosthetic valve endocarditis · right-sided endocarditis · culture-negative endocarditis
Consultant-physician-depth guide to infective endocarditis — pathogenesis, Modified Duke criteria, microbiology, antibiotic therapy (native vs prosthetic valve), surgical indications, prophylaxis, and complications — structured for FRACP DWE and DCE preparation.
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Target exams
Red flags
- New regurgitant murmur with heart failure — surgical emergency
- Staph aureus bacteraemia with prosthetic valve — presume IE until excluded
- Conduction block (PR prolongation) on ECG — aortic root abscess
- Vegetation greater than 10 mm with embolic event — urgent surgery
- Embolic stroke with haemorrhagic transformation — anticoagulation and surgery timing critical
- Fungal endocarditis — large friable vegetations, high embolic risk, surgical mandatory
Infective Endocarditis
Meet the patient
A 58-year-old with a bicuspid aortic valve presents with two weeks of fevers, night sweats and a new early diastolic murmur. Three blood cultures grow viridans streptococci, and the echo shows a mobile aortic vegetation.[1]
The two questions that decide his admission are the two that decide every case of endocarditis: is this definite IE? (the Modified Duke criteria answer that) and does he need the operating room? (heart failure answers that, more than any organism or vegetation size).[1]
References10ShowHide
- [1]Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis Clin Infect Dis, 2000.PMID 10770721
- [2]Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America Circulation, 2005.PMID 15956145
- [3]Fowler VG Jr, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: a consequence of medical progress JAMA, 2005.PMID 15972563
- [4]Moreillon P, Que YA Infective endocarditis Lancet, 2004.PMID 14726169
- [5]Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group Circulation, 2007.PMID 17446442
- [6]Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis N Engl J Med, 2012.PMID 22738096
- [7]Hubert S, Thuny F, Resseguier N, et al. Prediction of symptomatic embolism in infective endocarditis: construction and validation of a risk calculator in a multicenter cohort J Am Coll Cardiol, 2013.PMID 23906859
- [8]Thornhill MH, Dayer MJ, Forde JM, et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study BMJ, 2011.PMID 21540258
- [9]Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) Eur Heart J, 2015.PMID 26320109
- [10]Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis Eur Heart J, 2023.PMID 37622656