The document provides guidelines for the management of infective endocarditis from the European Society of Cardiology. It discusses definitions of infective endocarditis, recommendations for antibiotic prophylaxis, the role of echocardiography in diagnosis, etiologic agents, predictors of poor outcome, surgical indications, and treatment of various microorganisms including streptococci, staphylococci, enterococci, and culture-negative cases. It also addresses management considerations for infective endocarditis in specific patient populations such as those with prosthetic valves, congenital heart disease, or pregnancy.
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2015 ESC Guidelines for the Management of Infective Endocarditis
1. 2015 ESC Guidelines for the
management of infective
endocarditis
THE TASK FORCE FOR THE MANAGEMENT OF INFECTIVE ENDOCARDITIS OF
THE EUROPEAN SOCIETY OF CARDIOLOGY (ESC)
DR RISHI A BHARGAVA
2. INFECTIVE ENDOCARDITIS
Infection of the endocardial surface of the heart, which may
include one or more heart valves, the mural endocardium, or a
septal defect.
Varieties of IE that were uncommon in the early antibiotic era have
become prominent.
Cases of NIE, IVDA IE, and PVE have markedly increased.
Valvular infections have entered the era of IE caused by
intravascular devices and procedures.
16. Also more commonly seen -Pseudomonas aeruginosa , esp in
pentazocine addict
Candida is commonly implicated in heroin addict
The most common etiologic agent of infective endocarditis
- S. aureus
IV drug users
17. In patients with prosthetic valves, the microbiology is
somewhat dependent on
early (<12 months after valve replacement) versus
late (>I2 months) endocarditis.
18. Staphylococci- 40% to 60% of the cases of
early onset prosthetic valve endocarditis.
Coagulase-negative staphylococci - 30% to
35% of cases,
S. Aureus - 20% to 25%.
Late onset PVE – organisms same as native
valve disease.
19. • Fungal endocarditis -
• IV drug users,
• Recently undergonecardiovascular surgery,
• Received prolonged IV antibiotic therapy.
20. HACEK organisms
HACEK is an acronym for a group of
fastidious, slow-growing, gram-negative
bacteria
Account for approximately 5% to 10% of cases
of community-acquired endocarditis.
33. Antibiotic treatment - staphylo-
cocci
Native valve –
Methicilin susceptible /
methicillin resistant or pencilillin allergic
Prosthetic valve
Methicilin susceptible /
methicillin resistant or pencilillin allergic
No role of gentamicin in native valve staph infection.
Rifampicin is added 3-5 days after starting antibiotics in prosthetic
valve endocarditis.
53. Fewer systematic studies.
Incidence is lower in children(o.o4% per year ) than in adult(0.1%)
CHD with multiple lesion is at higher risk than simple lesion.
Mortality of 4-10 %. Prognosis is better than other forms.
Surgical repair of CHD reduces the risk, provided there is no residual
shunt.
Artificial valve substrate may increase the risk.
55. Incidence – 0.006%.
Higher inpatients with cardiac disease and further more
in pt with prosthetic valves.
Maternal mortality is approximately 33% ,with most death
relating to HF or an embolic event.
Foetal mortality is about 29%.
Rapid detection and appropriate treatment is important.
Despite the high foetal mortality , urgent surgery should
be performed in pt who present with HF due to acute
regurgitation.
56. “……..not to forget, they originated
millions of years before us ; and how to
survive, probably know better than us!!
“