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Infective endocarditis guidelines 2015

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Infective endocarditis guidelines 2015

  1. 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. 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.
  3. 3. Definitions
  4. 4. Prophylaxis
  5. 5. Patients requiring antibiotic prophylaxis:-
  6. 6. Non specific prevention measures in high and intermediate risk patient
  7. 7. Procedure requiring antibiotics prophylaxis
  8. 8. Contd….
  9. 9. Recommended prophylaxis for high risk procedures in high risk patients
  10. 10. Recommendations for cardiac and vascular procedures
  11. 11. ECHOCARDI- OGRAPHY IN DIAGNOSIS
  12. 12. Use of TTE and TEE:- Follow up during treatment Intra op during cardiac surgery After completion of therapy
  13. 13. Indication For Echocardiography In I.E.
  14. 14. The etiologic agents •Streptococci: 60%-80% . •Viridans streptococci: 30%-40% . •Other streptococci: 15%-25%. •Enterococci: 5%-18% . •Coagulase-positive organisms: 10%-27% •Coagulase-negative organisms: 1 %-3% •Gram-negative aerobic bacilli: 1% -13% •Fungi: 2%-4% Staphylococci: 20%-35%
  15. 15. 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
  16. 16. In patients with prosthetic valves, the microbiology is somewhat dependent on  early (<12 months after valve replacement) versus  late (>I2 months) endocarditis.
  17. 17. 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.
  18. 18. • Fungal endocarditis - • IV drug users, • Recently undergonecardiovascular surgery, • Received prolonged IV antibiotic therapy.
  19. 19. 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.
  20. 20. •H: Haemophilus parainfluenzae, Haemophilus aphrophilus, Haemophilus paraphrophilus, . Haemophilus influenzae . •A : Actinobacillus actinomycetemcomitans . •C : Cardiobacterium hominis . •E : Eikenella corrodens •K: Kingella kingae, Kingella denitrificans
  21. 21. Investigation of rare causes of I.E. (blood culture -ve)
  22. 22. Modified Duke’s criteria
  23. 23. Definition Of Different Criteria
  24. 24. ESC Algorithm For Diagnosis Of I.E.
  25. 25. Predictors of poor outcome in patient with infective endocardiris
  26. 26. Streptococcal bovis and oral streptococci Penicillin susceptible –  standard treatment – 2wk vs 4wk  beta lactam allergic Penicillin aresistant  Standard treatment  Beta lactam allergic
  27. 27. Antibiotic treatment - oral streptococci and streptococci bovis- penicillin susceptible
  28. 28. Penicillin resistance :
  29. 29. 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.
  30. 30. Antibiotic treatment - staphylo- cocci
  31. 31. Antibiotic treatment - staphylo- cocci – prosthetic valve
  32. 32. Antibiotic treatment - entero- cocci – prosthetic valve
  33. 33.  Antibiotic treatment of blood culture negative infective endocarditis
  34. 34. Antibiotic treatment of blood culture negative infective endocarditis
  35. 35. Empirical treatment
  36. 36. Empirical treatment of acutely severe ill patient
  37. 37. Outpatient Parenteral Antibiotic Therapy (OPAT)
  38. 38. SURGICAL MANAGEMENT
  39. 39. Indication and timing of surgery in left sided valve infective endocarditis
  40. 40. Indication for surgical treatment of right sided infective endocarditis
  41. 41. Factors associated with increase rate of relapse
  42. 42. Cardiac device related infective endocarditis (CDRIE)
  43. 43. Diagnosis
  44. 44. Principles of Treatment
  45. 45. Mode of device removal
  46. 46. Re-implantation
  47. 47. Prophylaxis
  48. 48. I.E. In congenital heart diseases
  49. 49.  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.
  50. 50. I.E. during pregnancy
  51. 51.  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.
  52. 52. “……..not to forget, they originated millions of years before us ; and how to survive, probably know better than us!! “

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