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Question 27 of 238

Six weeks after having a prosthetic heart valve a patient develops infective endocarditis. What is the most likely causative organism?

A. Streptococcus viridans B. Staphylococcus epidermidis C. Staphylococcus aureus D. Streptococcus bovis E. One of the HACEK group

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Most common cause of endocarditis: Streptococcus viridans Staphylococcus epidermidis if < 2 months post valve surgery

In the first two months following surgery for a prosthetic valve the most likely causative organism is Staphylococcus epidermidis Infective endocarditis The strongest risk factor for developing infective endocarditis is a previous episode of endocarditis. The following types of patients are affected: previously normal valves (50%, typically acute presentation) rheumatic valve disease (30%) prosthetic valves congenital heart defects intravenous drug users (IVDUs, e.g. Typically causing tricuspid lesion)

Causes Streptococcus viridans (most common cause - 40-50%) Staphylococcus epidermidis (especially prosthetic valves) Staphylococcus aureus (especially acute presentation, IVDUs) Streptococcus bovis is associated with colorectal cancer non-infective: systemic lupus erythematosus (Libman-Sacks), malignancy: marantic endocarditis

Culture negative causes prior antibiotic therapy Coxiella burnetii Bartonella Brucella HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)

Following prosthetic valve surgery Staphylococcus epidermidis is the most common organism in the first 2 months and is usually the result of perioperative contamination. After 2 months the spectrum of organisms which cause endocarditis return to normal, except with a slight increase in Staph. aureus infections

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