Infective endocarditis: Difference between revisions
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== Background == |
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* Infection of heart valves |
* Infection of heart valves, either prosthetic or native |
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* '''Bacteria''' |
* '''Bacteria''' |
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** [[Staphylococcus aureus]] (most common) |
** [[Staphylococcus aureus]] (most common) |
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** [[Viridans group streptococci]] |
** [[Viridans group streptococci]] |
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** [[Coagulase-negative |
** [[Coagulase-negative staphylococci]] |
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** Other streptococci |
** Other streptococci |
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** [[Enterococci]] |
** [[Enterococci]] |
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** ''[[Candidal endocarditis|Candida]]'' |
** ''[[Candidal endocarditis|Candida]]'' |
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== Presentation == |
== Clinical Presentation == |
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* Specific organisms may be associated with specific risk factors |
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* |
** Injection drug use: [[Viridans group streptococci]] and ''[[Pseudomonas aeruginosa]]'' |
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* Colon cancer: ''Streptococcus bovis'' and ''Clostridium septicum'' |
** Colon cancer: ''[Streptococcus bovis]]'' and ''[[Clostridium septicum]]'' |
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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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! 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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| 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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| 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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| Oxacillin-susceptible [[Staphylococcus]] |
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| PVE |
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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 |
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| [[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]] |
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Revision as of 01:12, 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
| 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
- ^ 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.
