Infective endocarditis

Infective endocarditis board questions usually focus on two main things: the treatment and prophylaxis. Diagnose is usually tested indirectly because you have to recognize the case through. reading the clinical scenario, you have to recognize it is infective endocarditis. Rarely they will tell you directly that it is infective endocarditis. The clinical scenario that you will get for treatment question is about a patient with risk factors.

Yeah, usually I be a drug user or previous endocarditis or prosthetic valve who has a fever, a marmor, positive blood culture, and they may give you some uh signs of the complication like stroke-like symptom, like cyptic embolas. Or sifting a blood to the lungs. When you read this question, you have to pay attention to clinical stability. Is the patient clinically stable by looking at the vital signs and symptoms of congestive heart failure of the patient having if they were?

tell you the patient having edema, shortness of breath, thrails. And also pay attention to aortic or valve regurgitation murmurs. And when you see septic emboli to the lungs, usually indicating a right-sided endocarditis, stroke-like symptoms or lesions to the

hands or legs usually indicate left sided endocarditis unless there is a PFO VSD or ASD you need to pay attention to those. Now treatment if the patient is clinically stable always pick to hold off an antibiotic until you get the blood culture results back. If the patient is clinically unstable, always start IV antibiotic as soon as possible. Always pick the choice that has IV vancomycin. If you cannot give IV vancomycin pick deptomycin.

pick linazolid and do not pick oral antibiotics. If you're treating community aquarinative valve endocarditis, IV vancomycin by itself is enough. If you're treating prosthetic valve endocarditis, you need to add probably Gintomycin uh to that. Uh if you're treating nosocomal endocarditis, you need to add also gintamycin and antisodomonal uh agents. The treatment usually four to six weeks total and you still

Start counting from the day the blood culture became negative, the more severe the endocarditis, the longer the period you need to treat. The only exception, remember that in right-sided, non-complicated methyl. sensitive stuff or it's endocarditis you can treat it for two weeks.

Only do not pick antiplatelets or anticoagulation to treat septic emboli at all. The next thing you need to pay attention is when to refer to cardiac surgery or when to pick valve replacement. Um and a general rule when there is worsening of the endocarditis, that there is lack of response to the antibiotic and worsening, always that an indication to um uh replace the valve. But generally speaking, when you see

See heart failure, symptoms, acute heart failure, symptoms associated with severe regurgitation. You need to uh refer to surgery. When you need that the patient is not responding to antibiotics, the blood culture after five to seven days is still positive.

You need to refer for surgery. When you need as you see septic emboli despite antibiotic therapies, stroke like symptoms, uh septic emboli into the lungs, uh that's with antibiotic, you need to refer to surgery. Now pay attention if this septic emboli were pretty.

Present before starting antibiotic, you need to give antibiotic five to seven days. And while on antibiotic, if they're getting worse, you need to refer to surgery. If you see bradycardia and the questions and an AKG showing complete hot block, that's also a clue that you need a

complete uh you need a valve replacement if there is telling you an echo with the valvular abscess always go for valve replacement if the blood culture is telling you it's fungi replace the valve if it's a resistant multi-drug resistant organ organism as well go for valve replacement and one thing you need to memorize still is if there is mechanical oh sorry if it's a mechanical prosthetic valve and you have staph aureus you need also to replace

the valve um with that so these are the main question you will get uh regarding the treatment the next uh you the next topic usually they ask about it is the prophylaxis

And the scenario always they want to test you which patient you need to uh really give antibiotic before they don't test usually what kind of procedure, although you need to know that. But generally they present a patient with Dental procedure, and they will tell you whether you give antibiotic or not. So this is common sense. Anybody with previous endocarditis, you need to give them prophylaxis. Anyone with any kind of prophylaxis. ΦΡΡΕΡΕΡΕΡΕΡΕΡΑΣ

Prosthetic valve, whether mechanical or biovalve, you need to treat with you need to give prophylaxis. Any kind of prosthetic, uh, not necessarily a valve. Whenever they mention something prosthetic, even to correct some congenital. Heart disease, you need to give prophylactic. So the word prosthetic always a clue that you need to give prophylactic antibiotics, uh, unprepared congenital heart disease, cyanetic congenital heart disease. Um you need to

Give uh that so probably need to memorize the unrepaired cyanetic congenital heart disease or repair with some prosthesis, as we mentioned. Also, pay attention if it's partially repaired only, you need to give prophylaxic and antibiotic and the last things remember something valuable it's not easy to get which is the heart transplant if there is any valvular disease in a heart transplant you need to give prophylactic antibiotic for endocarditis you you don't you do not want to waste that heart

transplant now procedure wise technically anything that will induce bacteria So then tell procedure this is the most common one that will come with the questions, so you need you need always to Give that. Now bronchoscopy if there is a biopsy or insygen you need to give prophylactic antibiotics. Regular colonoscopy. Colonoscopy with or without biopsy, you do not need

EGD, upper endoscopy, you do not need whether or not biopsy or anything. Cystoscopy, you don't need. Cesarean section, you don't need. Vaginal delivery, you do not need it. The only time you need it. Let's say you're doing cystoscopy on somebody with UTI or pylonephritis, and those patients are already on antibiotics, right? So you need to pay attention, or you're doing ERCP for somebody with colongitis, or you're doing colonoscopy on

Somebody with active colitis. So when there is an ongoing infection, always pick to give prophylactic antibiotics. Let's say treating septic arthritis. You need to play with that joint. You need to give, or you have to do breed a Always when there's a risk of bacteria, you need to get prophylactic antibiotic. But remember colonoscopy, no. AGD, no, vaginal delivery, no, uh cesar insection, no, bronchoscopy without any biopsy or incision, no.

So these are the main things. Usually you give amoxicillin 2 grams 30 to 60 minutes before the procedure. If the patient is allergic to amoxicillin, give clindamycin. If the patient cannot take PO, you give rosefin, IV. Or ampicillin IV. Let's say the patient was already on amoxicillin for some other reason, and now we need to give prophylactic antibiotics. Some they suggest you switch to a different class of antibiotics just for the prophylaxis. So these are the

Things for prophylaxis. Unfortunately, you have to memorize That on the or the night exam if you don't know but to make it easy Previous history of endocarditis, heart transplant with valve problems, any word prosthesis in the question, please go ahead and give them prophylactic antibiotics. Thanks for listening to this podcast. Please do not forget.

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