Infective endocarditis ESC guidelines Ahmed Yehia. MD
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Infective endocarditis ESC guidelines Ahmed Yehia. MD Internal Medicine, Faculty of Medicine, Beni-Suef University Infective endocarditis criteria ESC guidelines 2015 Blood culture negative infective endocarditis BCNIE Prevention of endocarditis Indications of surgery in IE Anticoagulant in IE
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Semelhante a Infective endocarditis ESC guidelines Ahmed Yehia. MD
Semelhante a Infective endocarditis ESC guidelines Ahmed Yehia. MD (20)
Mais de Internal medicine department, faculty of Medicine Beni-Suef University Egypt
Mais de Internal medicine department, faculty of Medicine Beni-Suef University Egypt (20)
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Infective endocarditis ESC guidelines Ahmed Yehia. MD
- 2. Case from “Prognosis” app Unexplained fever + new murmur = IE until proven otherwise.
- 4. •Endocardium
- 6. IE NVE PVE
- 7. IE Community- associated Health care- associated: onset of symptoms ≥48 hours after hospitalization
- 8. IE ABE SBE
- 9. Acute Subacute Affects normal heart valves Often affects damaged heart valves Rapidly destructive Indolent nature If not treated, usually fatal within 6 weeks If not treated, usually fatal by one year Commonly Staph Metastatic foci Commonly viridans Streptococci خطير مكير
- 10. The intact, healthy endocardium is typically resistant to bacterial seeding.
- 11. Pathogenesis Altered valve surface Turbulent blood flow Deposition of platelets and fibrin nonbacterial thrombotic vegetation (NBTE) Bacteraemia, bacteria attaches to platelet-fibrin deposits Vegetations
- 15. Acute S. aureus IE with perforation of the aortic valve and aortic valve vegetations. Acute S. aureus IE with mitral valve ring abscess extending into myocardium.
- 16. The development of infective endocarditis requires combination of 2 factors : I. Infection. II. Underlying cardiac disease.
- 17. Risk factors Bacteria Heart lesion Structural cardiac abnormality 75% have a preexisting structural cardiac abnormality 10-20% have congenital heart disease e.g. Injection drug use 100X risk in young Staphyaureusus 1. Hemodialys is 2. DM 3. HIV
- 19. Risk Factors ; Cardiac Abnormalit y High risk • Previous IE • Aortic valve disease • Rheumatic valve disease • Prosthetic valve • Coarctation • Complex cyanotic congenital Moderate risk • MVP w/ MR/thickened leaflets • Mitral Stenosis • tricuspid valve • Pulmonary Stenosis • Hypertrophic Obstructive Cardiomyopathy (HOCM) Low/no risk • ASD (secundum) • CABG
- 20. Aetiological Agents 1. Streptococci • Viridans streptococci/α-haemolytic streptococci • S. mitis, S. sanguis, S. oralis • S. bovis • Associated with colonic carcinoma 2. Enterococci • E. faecalis, E. faecium • Associated with GU/GI tract procedures • Approx. 10% of patients with enterococcal bacteraemia develop endocarditis
- 21. Aetiological Agents 3. Staphylococci Staphylococcci have surpassed viridans streptococci as the most common cause of infective endocarditis S. aureus • Native valves • acute endocarditis Coagulase-negative staphylococci • Prosthetic valve endocarditis
- 22. Aetiological Agents 4. Gram-negative rods • HACEK group • Haemophilus aphrophilus, • Actinobacillus actinomycetemcomitans, • Cardiobacterium hominis, • Eikenella corrodens, • Kingella kingae. • E. coli, Klebsiella etc • Uncommon • Pseudomonas aeruginosa • IVDA • Neisseria gonorrhoae • Rare since introduction of penicillin
- 23. Aetiological Agents (Others) Fungi (1%) • Candida species, Aspergillus species Q fever Chlamydia Bartonella Legionella
- 25. Prevention Procedures at risk of IE Procedure at highest risk of IE Cardiac conditions at risk of IE Cardiac conditions at highest risk of IE
- 28. blue Cardiac conditions at highestriskof IE
- 29. Procedures at highest risk of IE
- 30. Prophylaxis for dental procedures at risk Alternatively, cephalexin2 g i.v. for adults or 50 mg/kg i.v. for children, cefazolin or ceftriaxone1 g i.v. for adults or 50 mg/kg i.v. for children. “Cephalosporins should not be used in patients with anaphylaxis, angio-oedema, or urticaria after intake of penicillin or ampicillin due to cross-sensitivity”.
- 34. Diagnosis requires high index of suspicion.
- 38. Fever • Immunosuppression, old age, antipyretic use, or previous antibiotic courses may prevent manifestation.
- 39. Consider in PUO, do transthoracic echocardiography (TTE) •Even if negative TTE
- 44. Osler nodes
- 47. Septic Pulmonary Emboli Septic Retinal embolus http://www.emedicine.com/emerg/topic164.htm
- 51. Diagnostic approach 1-Positive blood culture results A minimum of three blood cultures should be obtained over a time period based upon the severity of the illness 2-Additional laboratory Nonspecific test An elevated ESR and/or an elevated level of CRP is usually present Most patients quickly develop a normochromic normocytic anemia The WBC count may be normal or elevated.
- 52. Case • A 30-year-old female
- 53. Case from “Prognosis” app Unexplained fever + new murmur = IE until proven otherwise. What is the next step? Mr. Ahmed
- 54. Blood culture Surprisingly, it came negative.
- 55. When culture is negative, don’t forget to ask about…… ANTIBIOTICS
- 56. Case from “Prognosis” app Unexplained fever + new murmur = IE until proven otherwise. What is the next step? Mr. Ali
- 57. Blood culture Surprisingly, it came negative.
- 58. When culture is negative, don’t forget to ask about…… ANTIBIOTICS
- 63. Anatomicand & echographic definitions
- 66. Modified Duke Criteria • Definite : 2 major criteria : 1 major and 3 minor criteria : 5 minor criteria : pathology/histology findings • Possible : 1 major and 1 minor criteria : 3 minor criteria Rejected : firm alternate diagnosis : resolution of manifestations of IE with 4 days antimicrobial therapy or less
- 68. ESC 2015 modified criteria for diagnosis of IE
- 71. MANAGEMENT
- 72. Management
- 81. Antibiotic treatment for BCNIE
- 82. Indications and timing of surgery • Endocarditis team
Notas do Editor
- Health care-associated recent contact with a health care setting, with onset of symptoms ≥48 hours after hospitalization
- نمنع هذه العلاقة غير الشرعية
- repeatedly injecting drugs intravenously produces track marks. Track marks are lines of tiny, dark dots (needle punctures) surrounded by an area of darkened or discolored skin. Injecting drugs under the skin causes circular scars or ulcers. People who inject drugs may claim other reasons for the marks, such as frequent blood donations, bug bites, or other injuries.
- SBE: subtle non-specific symptoms
- repeatedly injecting drugs intravenously produces track marks. Track marks are lines of tiny, dark dots (needle punctures) surrounded by an area of darkened or discolored skin. Injecting drugs under the skin causes circular scars or ulcers. People who inject drugs may claim other reasons for the marks, such as frequent blood donations, bug bites, or other injuries.
- repeatedly injecting drugs intravenously produces track marks. Track marks are lines of tiny, dark dots (needle punctures) surrounded by an area of darkened or discolored skin. Injecting drugs under the skin causes circular scars or ulcers. People who inject drugs may claim other reasons for the marks, such as frequent blood donations, bug bites, or other injuries.
- repeatedly injecting drugs intravenously produces track marks. Track marks are lines of tiny, dark dots (needle punctures) surrounded by an area of darkened or discolored skin. Injecting drugs under the skin causes circular scars or ulcers. People who inject drugs may claim other reasons for the marks, such as frequent blood donations, bug bites, or other injuries.
- repeatedly injecting drugs intravenously produces track marks. Track marks are lines of tiny, dark dots (needle punctures) surrounded by an area of darkened or discolored skin. Injecting drugs under the skin causes circular scars or ulcers. People who inject drugs may claim other reasons for the marks, such as frequent blood donations, bug bites, or other injuries.