Infective endocarditis: Difference between revisions
From IDWiki
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* Varies by causative organism and prosthetic vs. native valve |
* Varies by causative organism and prosthetic vs. native valve |
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{| class="wikitable |
{| class="wikitable" |
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! Organism |
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! Indication |
! Indication |
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! Antibiotic |
! Antibiotic |
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! Notes |
! Notes |
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|- |
|- |
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| MSSA and other oxacillin-susceptible [[Staphylococcus]] |
! colspan=5 | MSSA and other oxacillin-susceptible ''[[Staphylococcus]]'' |
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|- |
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| NVE |
| NVE |
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| [[oxacillin]] || 12 g/day IV in 4-6 |
| [[oxacillin]] || 12 g/day IV in 4-6 doses || 6 weeks |
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| can treat for 2 weeks in uncomplicated right-sided NVE |
| can treat for 2 weeks in uncomplicated right-sided NVE |
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|- |
|- |
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| ⚫ | |||
| NVE |
| NVE |
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| [[cefazolin]] || 6 g/day IV in 3 |
| [[cefazolin]] || 6 g/day IV in 3 doses || 6 weeks |
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| in patients with non-anaphylactoid penicillin allergy |
| in patients with non-anaphylactoid penicillin allergy |
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|- |
|- |
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| rowspan=3 | PVE |
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| MRSA and other oxacillin-resistant [[Staphylococcus]] |
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| [[oxacillin]], plus |
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| 12 g/day in 6 doses |
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| rowspan=2 | ≥6 weeks |
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| ⚫ | |||
|- |
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| [[rifampin]], plus |
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| 900 mg/day IV/PO in 3 doses |
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|- |
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| [[gentamicin]] |
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| 3 mg/kg/day IV/IM in 2-3 doses |
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| 2 weeks |
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|- |
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| ⚫ | |||
|- |
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| NVE |
| NVE |
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| [[vancomycin]] || 30 mg/kg/day IV in 2 |
| [[vancomycin]] || 30 mg/kg/day IV in 2 doses || 6 weeks |
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| target trough 10-20 μg/mL |
| target trough 10-20 μg/mL |
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|- |
|- |
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| MRSA and other oxacillin-resistant [[Staphylococcus]] |
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| NVE |
| NVE |
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| [[daptomycin]] || ≥8 mg/kg/dose || 6 weeks |
| [[daptomycin]] || ≥8 mg/kg/dose || 6 weeks |
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| |
| |
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|- |
|- |
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| rowspan=3 | PVE |
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| MSSA and other oxacillin-susceptible [[Staphylococcus]] |
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| [[vancomycin]], plus |
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| ⚫ | |||
| 30 mg/kg/day in 2 doses |
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| [[oxacillin]], plus<br/>[[rifampin]], plus<br/>[[gentamicin]] |
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| rowspan=2 | ≥6 weeks |
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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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| ⚫ | |||
|- |
|- |
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| [[rifampin]], plus |
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| MRSA and other oxacillin-resistant [[Staphylococcus]] |
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| 900 mg/day IV/PO in 3 doses |
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| ⚫ | |||
|- |
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| [[vancomycin]], plus<br/>[[rifampin]], plus<br/>[[gentamicin]] |
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| [[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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| 3 mg/kg/day IV/IM in 2-3 doses |
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| ≥6 weeks<br/>≥6 weeks<br/>2 weeks |
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| 2 weeks |
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| ⚫ | |||
|- |
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! colspan=5 | ''[[Enterococcus]]'' susceptible to [[penicillin]] and [[gentamicin]] |
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|- |
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| rowspan=2 | NVE or PVE |
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| [[ampicillin]], plus |
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| 2 g IV q4h |
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| rowspan=2 | 4-6 weeks |
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| rowspan=2 | 4 weeks if symptoms <3 months; 6 weeks if symptoms >3 months or if PVE |
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|- |
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| [[gentamicin]] |
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| 3 mg/kg IBW in 2-3 doses |
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|- |
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| rowspan=2 | NVE or PVE |
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| [[ampicillin]], plus |
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| 2 g IV q4h |
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| rowspan=2 | 6 weeks |
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| rowspan=2 | alternative regimen if CrCl <50 |
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|- |
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| [[ceftriaxone]] |
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| 2 g IV q12h |
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|- |
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! colspan=5 | ''[[Enterococcus]]'' susceptible to [[penicillin]] and resistant to [[aminoglycosides]] |
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|- |
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| rowspan=2 | NVE or PVE |
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| [[ampicillin]], plus |
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| 2 g IV q4h |
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| rowspan=2 | 6 weeks |
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| rowspan=2 | |
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|- |
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| [[ceftriaxone]] |
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| 2 g IV q12h |
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|- |
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! colspan=5 | ''[[Enterococcus]]'' resistant to [[penicillin]] and susceptible to [[vancomycin]] and [[aminoglycosides]] |
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|- |
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| rowspan=2 | NVE or PVE |
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| [[vancomycin]], plus |
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| 30 mg/kg/day IV in 2 doses |
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| rowspan=2 | 6 weeks |
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| rowspan=2 | |
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|- |
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| [[gentamicin]] |
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| 3 mg/kg/day IV/IM in 3 doses |
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|- |
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! colspan=5 | ''[[Enterococcus]]'' resistant to [[penicillin]], [[aminoglycosides]], and [[vancomycin]] |
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|- |
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| ⚫ | |||
| [[linezolid]] |
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| 600 mg IV/PO q12h |
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| >6 weeks |
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| |
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|- |
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| ⚫ | |||
| [[daptomycin]] |
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| 10-12 mg/kg/dose |
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| >6 weeks |
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| |
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|} |
|} |
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Revision as of 01:39, 10 March 2020
Background
- Infection of heart valves, either prosthetic or native
Organisms
- Bacteria
- Staphylococcus aureus (most common)
- Viridans group streptococci
- Coagulase-negative staphylococci
- Other streptococci
- Enterococci
- HACEK group
- Coxiella
- Brucella
- Fungi
Clinical Presentation
- Refer to Modified Duke criteria
- Specific organisms may be associated with specific risk factors
- Injection drug use: Viridans group streptococci and Pseudomonas aeruginosa
- Colon cancer: [Streptococcus bovis]] and Clostridium septicum
Management
- Varies by causative organism and prosthetic vs. native valve
| Indication | Antibiotic | Dose | Duration | Notes |
|---|---|---|---|---|
| MSSA and other oxacillin-susceptible Staphylococcus | ||||
| NVE | oxacillin | 12 g/day IV in 4-6 doses | 6 weeks | can treat for 2 weeks in uncomplicated right-sided NVE |
| NVE | cefazolin | 6 g/day IV in 3 doses | 6 weeks | in patients with non-anaphylactoid penicillin allergy |
| PVE | oxacillin, plus | 12 g/day in 6 doses | ≥6 weeks | use cefazolin or vancomycin if allergy |
| rifampin, plus | 900 mg/day IV/PO in 3 doses | |||
| gentamicin | 3 mg/kg/day IV/IM in 2-3 doses | 2 weeks | ||
| MRSA and other oxacillin-resistant Staphylococcus | ||||
| NVE | vancomycin | 30 mg/kg/day IV in 2 doses | 6 weeks | target trough 10-20 μg/mL |
| NVE | daptomycin | ≥8 mg/kg/dose | 6 weeks | |
| PVE | vancomycin, plus | 30 mg/kg/day in 2 doses | ≥6 weeks | target vancomycin trough of 10-20 μg/mL |
| rifampin, plus | 900 mg/day IV/PO in 3 doses | |||
| gentamicin | 3 mg/kg/day IV/IM in 2-3 doses | 2 weeks | ||
| Enterococcus susceptible to penicillin and gentamicin | ||||
| NVE or PVE | ampicillin, plus | 2 g IV q4h | 4-6 weeks | 4 weeks if symptoms <3 months; 6 weeks if symptoms >3 months or if PVE |
| gentamicin | 3 mg/kg IBW in 2-3 doses | |||
| NVE or PVE | ampicillin, plus | 2 g IV q4h | 6 weeks | alternative regimen if CrCl <50 |
| ceftriaxone | 2 g IV q12h | |||
| Enterococcus susceptible to penicillin and resistant to aminoglycosides | ||||
| NVE or PVE | ampicillin, plus | 2 g IV q4h | 6 weeks | |
| ceftriaxone | 2 g IV q12h | |||
| Enterococcus resistant to penicillin and susceptible to vancomycin and aminoglycosides | ||||
| NVE or PVE | vancomycin, plus | 30 mg/kg/day IV in 2 doses | 6 weeks | |
| gentamicin | 3 mg/kg/day IV/IM in 3 doses | |||
| Enterococcus resistant to penicillin, aminoglycosides, and vancomycin | ||||
| NVE or PVE | linezolid | 600 mg IV/PO q12h | >6 weeks | |
| NVE or PVE | daptomycin | 10-12 mg/kg/dose | >6 weeks | |
References
- ^ 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.
- ^ 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.
- ^ 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.
