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
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
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.
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
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”.
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.
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
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.