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Endocarditis, Infective

Samantha Faryn Gottlieb, DO, MS and Theodore B. Flaum, DO, FACOFP Reviewed 06/2019
 


BASICS

DESCRIPTION

  • An infection of the valvular (primarily) and/or mural (rarely) endocardium

  • System(s) affected: cardiovascular, endocrine/metabolic, hematologic/lymphatic, immunologic, pulmonary, rena...

DIAGNOSIS

  • Modified Duke Criteria (1)[B] (definite: 2 major criteria, or 1 major and 3 minor criteria, or 5 minor criteria; possible: 1 major and 1 minor or 3 minor criteria)

  • Major clinical criteria

    • Posi...

TREATMENT

MEDICATION

First Line

  • Start empiric treatment after three sets of blood cultures have been drawn. Results guide treatment.

    • Native valves: ampicillin-sulbactam 12 g/day IV divided into 4 doses w...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Check gentamicin peak (~3 μg/mL) and trough (<1 μg/mL) levels if used for >5 days and with renal dysfunction. Perform twice-weekly BUN and...

REFERENCES

1
Baddour LM, Wilson WR, Bayer AS, et al; for American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Youn...

CODES

ICD10

  • I33.0 Acute and subacute infective endocarditis

  • I39 Endocarditis and heart valve disord in dis classd elswhr

  • A54.83 Gonococcal heart infection

  • B37.6 Candidal endocarditis

ICD9

  • 421.0 Acute and su...

CLINICAL PEARLS

  • Antibiotic prophylaxis is recommended for patients with artificial heart valves, history of IE, CHD, and cardiac transplants with valvulopathy.

  • TEE/TTE and blood cultures are the mainst...

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