Infective endocarditis
From IDWiki
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 | |
Viridans Streptococcus or Streptococcus gallolyticus highly susceptible to penicillin (MIC ≤0.12 μg/mL) | ||||
NVE | crystalline penicillin G | 12-18 MU/day IV in 4-6 doses | 4 weeks | |
NVE | ceftriaxone | 2 g IV/IM q24h | 4 weeks | |
NVE | penicillin or ceftriaxone, plus | as above | 2 weeks | |
gentamicin | 3 mg/kg IV/IM q24h | |||
NVE | vancomycin | 30 mg/kg/day IV in 2 doses | 4 weeks | use if allergy, target 10-15 μg/mL |
PVE | crystalline penicillin G, or | 24 MU/day IV in 4-6 doses | 6 weeks | |
ceftriaxone, with or without | 2 g IV/IM q24h | |||
gentamicin | 3 mg/kg IV/IM q24h | 2 weeks | ||
PVE | vancomycin | 30 mg/kg/day IV in 2 doses | 6 weeks | use if allergy |
Viridans Streptococcus or Streptococcus gallolyticus relatively resistant to penicillin (MIC >0.12 μg/mL) | ||||
NVE | crystalline penicillin G, plus | 24 MU/day IV in 4-6 doses | 4 weeks | |
gentamicin | 3 mg/kg IV/IM q24h | |||
NVE | vancomycin | 30 mg/kg/day IV in 2 doses | 4 weeks | use if allergy, target 10-15 μ/mL |
PVE | crystalline penicillin G, or | 24 MU/day IV in 4-6 doses | 6 weeks | |
ceftriaxone, plus | 2 g IV/IM q24h | |||
gentamicin | 3 mg/kg IV/IM q24h | |||
PVE | vancomycin | 30 mg/kg/day IV in 2 doses | 6 weeks | use if allergy |
Streptococcus pneumoniae | ||||
NVE | penicillin | 4 weeks | ||
NVE | cefazolin | 4 weeks | ||
NVE | ceftriaxone | 4 weeks | ||
PVE | penicillin | 6 weeks | ||
PVE | cefazolin | 6 weeks | ||
PVE | ceftriaxone | 6 weeks | ||
Streptococcus pyogenes | ||||
NVE | crystalline penicillin G | 4 weeks | ||
NVE | ceftriaxone | 4 weeks | ||
PVE | crystalline penicillin G | 6 weeks | ||
PVE | ceftriaxone | 6 weeks | ||
Group B, C, or G Streptococcus | ||||
NVE | crystalline penicillin G, with or without | 4 weeks | ||
gentamicin | 2 weeks | |||
NVE | ceftriaxone, with or without | 4 weeks | ||
gentamicin | 2 weeks | |||
PVE | crystalline penicillin G, with or without | 6 weeks | ||
gentamicin | 2 weeks | |||
PVE | ceftriaxone, with or without | 6 weeks | ||
gentamicin | 2 weeks | |||
HACEK bacterium | ||||
NVE | ceftriaxone | 2 g IV/IM q24h | 4 weeks | |
PVE | ceftriaxone | 2 g IV/IM q24h | 6 weeks | |
NVE or PVE | ciprofloxacin | 1000 mg/day PO in 2 doses | 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.