Infective Endocarditis

Morning Report
1.14.11
Jenny Levin, MD
 Who gets IE?
• Risk Factors
– Rheumatic Heart Disease (historical, prior to 1970)
– Congenital heart disease requiring surgical
intervention (30-50%)
– Central venous catheters (CVC)

 True incidence is unknown

  Pathophysiology: Early steps in bacterial valve colonisation.

Prendergast B D Heart 2006;92:879-885

©2006 by BMJ Publishing Group Ltd and British Cardiovascular Society

Diagnosis – Modified Duke Criteria
• Major Criteria
– Positive blood culture
– Evidence of endocardial involvement (echo)
• Minor Criteria
– Predisposing factor
– Fever (38.0)
– Vascular phenomena
– Immunologic phenomena
– Micro evidence

• To make the Dx you must have: 2 major, 1 major + minor, or

5 minor
17 yo male with Staph aureus endocarditis involving the mitral valve
 Treatment
• Organism dependent
• LONG!
– Usually 4-6 weeks
• May require combination therapy
• Surgical intervention for complicated cases

• Morbidity
– cardiac sequelae (eg, heart failure and perivalvar infection)
– end-organ infection and infarction due to embolic events
• Mortality approximately 5%