Infective endocarditis: Difference between revisions

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(cleaned up, and added management table with staphylococci)
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== Background ==
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* Infection of heart valves
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* Infection of heart valves, either prosthetic or native
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⚫
== Organisms ==
  
   
  ⚫
=== Organisms ===
 
* '''Bacteria'''
  
* '''Bacteria'''
 
** [[Staphylococcus aureus]] (most common)
  
** [[Staphylococcus aureus]] (most common)
 
** [[Viridans group streptococci]]
  
** [[Viridans group streptococci]]
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** [[Coagulase-negative Staphylococci]]
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** [[Coagulase-negative staphylococci]]
 
** Other streptococci
  
** Other streptococci
 
** [[Enterococci]]
  
** [[Enterococci]]
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** ''[[Candidal endocarditis|Candida]]''
  
** ''[[Candidal endocarditis|Candida]]''
   
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== Presentation ==
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== Clinical Presentation ==
  ⚫
* Refer to [[Modified Duke criteria]]
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* Specific organisms may be associated with specific risk factors
⚫
* [[Modified Duke criteria]]
  
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* IVDU: Viridans group streptococci and ''Pseudomonas aeroginosa''
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** Injection drug use: [[Viridans group streptococci]] and ''[[Pseudomonas aeruginosa]]''
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* Colon cancer: ''Streptococcus bovis'' and ''Clostridium septicum''
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** Colon cancer: ''[Streptococcus bovis]]'' and ''[[Clostridium septicum]]''
   
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== Treatment ==
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== Management ==
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* Varies by causative organism and prosthetic vs. native valve
   
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{| class="wikitable"
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* MSSA native valve endocarditis
  
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! Organism
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** [[Cloxacillin]] or [[cefazolin]]
  
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! Indication
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** OR [[Vancomycin]]/[[Daptomycin]]
  
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! Antibiotic
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* MSSA prosthetic valve endocarditis
  
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! Dose
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** [[Cloxacillin]] PLUS [[rifampin]] PLUS 2 weeks of [[gentamicin]]
  
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! Duration
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** OR [[Vancomycin]]/[[Daptomycin]], other things
  
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! Notes
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* 6 weeks
  
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|-
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| Oxacillin-susceptible [[Staphylococcus]]
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| NVE
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| [[oxacillin]] || 12 g/day IV in 4-6 divided doses || 6 weeks
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| can treat for 2 weeks in uncomplicated right-sided NVE
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|-
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| Oxacillin-susceptible [[Staphylococcus]]
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| NVE
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| [[cefazolin]] || 6 g/day IV in 3 divided doses || 6 weeks
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| in patients with non-anaphylactoid penicillin allergy
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|-
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| Oxacillin-resistant [[Staphylococcus]]
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| NVE
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| [[vancomycin]] || 30 mg/kg/day IV in 2 divided doses || 6 weeks
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| target trough 10-20 μg/mL
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|-
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| Oxacillin-resistant [[Staphylococcus]]
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| NVE
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| [[daptomycin]] || ≥8 mg/kg/dose || 6 weeks
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|
  +
|-
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| Oxacillin-susceptible [[Staphylococcus]]
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| PVE
  ⚫
| [[oxacillin]], plus<br/>[[rifampin]], plus<br/>[[gentamicin]]
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| 12 g/day in 6 divided doses<br/>900 mg/day IV or PO in 3 divided doses<br/>3 mg/kg/day IV or IM in 2-3 divided doses
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| ≥6 weeks<br/>≥6 weeks<br/>2 weeks
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| use cefazolin or vancomycin if allergy
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|-
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| Oxacillin-resistant [[Staphylococcus]]
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| PVE
  +
| [[vancomycin]], plus<br/>[[rifampin]], plus<br/>[[gentamicin]]
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| 30 mg/kg/day in 2 divided doses<br/>900 mg/day IV or PO in 3 divided doses<br/>3 mg/kg/day IV or IM in 2-3 divided doses
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| ≥6 weeks<br/>≥6 weeks<br/>2 weeks
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| target trough of 10-20 μg/mL
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|}
   
 
[[Category:Cardiac infections]]
  
[[Category:Cardiac infections]]

Revision as of 20:12, 9 March 2020

Background

  • Infection of heart valves, either prosthetic or native

Organisms

Clinical Presentation

Management

  • Varies by causative organism and prosthetic vs. native valve
Organism Indication Antibiotic Dose Duration Notes
Oxacillin-susceptible Staphylococcus NVE oxacillin 12 g/day IV in 4-6 divided doses 6 weeks can treat for 2 weeks in uncomplicated right-sided NVE
Oxacillin-susceptible Staphylococcus NVE cefazolin 6 g/day IV in 3 divided doses 6 weeks in patients with non-anaphylactoid penicillin allergy
Oxacillin-resistant Staphylococcus NVE vancomycin 30 mg/kg/day IV in 2 divided doses 6 weeks target trough 10-20 μg/mL
Oxacillin-resistant Staphylococcus NVE daptomycin ≥8 mg/kg/dose 6 weeks
Oxacillin-susceptible Staphylococcus PVE oxacillin, plus
rifampin, plus
gentamicin 		12 g/day in 6 divided doses
900 mg/day IV or PO in 3 divided doses
3 mg/kg/day IV or IM in 2-3 divided doses 		≥6 weeks
≥6 weeks
2 weeks 		use cefazolin or vancomycin if allergy
Oxacillin-resistant Staphylococcus PVE vancomycin, plus
rifampin, plus
gentamicin 		30 mg/kg/day in 2 divided doses
900 mg/day IV or PO in 3 divided doses
3 mg/kg/day IV or IM in 2-3 divided doses 		≥6 weeks
≥6 weeks
2 weeks 		target trough of 10-20 μg/mL

References

  1. ^  Kasper Iversen, Nikolaj Ihlemann, Sabine U. Gill, Trine Madsen, Hanne Elming, Kaare T. Jensen, Niels E. Bruun, Dan E. Høfsten, Kurt Fursted, Jens J. Christensen, Martin Schultz, Christine F. Klein, Emil L. Fosbøll, Flemming Rosenvinge, Henrik C. Schønheyder, Lars Køber, Christian Torp-Pedersen, Jannik Helweg-Larsen, Niels Tønder, Claus Moser, Henning Bundgaard. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. New England Journal of Medicine. 2019;380(5):415-424. doi:10.1056/nejmoa1808312.
  2. ^  John A Wildenthal, Andrew Atkinson, Sophia Lewis, Sena Sayood, Nathanial S Nolan, Nicolo L Cabrera, Jonas Marschall, Michael J Durkin, Laura R Marks. Outcomes of Partial Oral Antibiotic Treatment for Complicated Staphylococcus aureus Bacteremia in People Who Inject Drugs. Clinical Infectious Diseases. 2022;76(3):487-496. doi:10.1093/cid/ciac714.
  3. ^  Sarah Freling, Noah Wald-Dickler, Josh Banerjee, Catherine P Canamar, Soodtida Tangpraphaphorn, Dara Bruce, Kusha Davar, Fernando Dominguez, Daniel Norwitz, Ganesh Krishnamurthi, Lilian Fung, Ashley Guanzon, Emi Minejima, Michael Spellberg, Catherine Spellberg, Rachel Baden, Paul Holtom, Brad Spellberg. Real-World Application of Oral Therapy for Infective Endocarditis: A Multicenter, Retrospective, Cohort Study. Clinical Infectious Diseases. 2023;77(5):672-679. doi:10.1093/cid/ciad119.

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