Microbiological diagnosis infective endocarditis
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Basics in infective endocarditis by Mohmmad Mukhit Kazi
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Microbiological diagnosis infective endocarditis
- 1. Mr. Mohammad Mukhit Kazi Assistant professor Department of General Pathology and Microbiology Sinhgad Dental College and Hospital Pune Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 2. To know in brief about the bacterial endocarditis To know the risk factors for endocarditis To know the most common etiological agents in endocariditis To know the common steps in the laboratory diagnosis – microbiological To know the possible cause of negative cultures in endocarditis Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 3. Endocarditis Septic thrombophlebitis Mycotic aneurysm Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 4. Infective Endocarditis: a microbial infection of the endocardial surface of the heart Common site: heart valve, but may occur at septal defect, on chordae tendinae or in the mural endocardium Classification: ◦ acute or subacute-chronic on temporal basis, severity of presentation and progression ◦ By organism ◦ Native valve or prosthetic valve Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 5. Bacteraemia ◦ Transient bacteraemia occurs when a heavily colonised mucosal surface is traumatised Dental extraction Periodontal surgery Tooth brushing Tonsillectomy Operations involving the respiratory, GI or GU tract mucosa Oesophageal dilatation Biliary tract surgery Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 6. 1. Streptococci ◦ Viridans streptococci/α-haemolytic streptococci S. mitis, S. sanguis, S. oralis ◦ S. bovis Associated with colonic carcinoma 1. Enterococci E. faecalis, E. faecium Associated with GU/GI tract procedures Approx. 10% of patients with enterococcal bacteraemia develop endocarditis Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 7. 3. Staphylococci Staphylococcci have surpassed viridans streptococci as the most common cause of infective endocarditis ◦ S. aureus Native valves acute endocarditis ◦ Coagulase-negative staphylococci Prosthetic valve endocarditis Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 8. 4. Gram-negative rods ◦ HACEK group Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae. Fastidious oropharyngeal GNBs ◦ E. coli, Klebsiella etc Uncommon ◦ Pseudomonas aeruginosa IVDA ◦ Neisseria gonorrhoae Rare since introduction of penicillin Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 9. 5. Others ◦ Fungi Candida species, Aspergillus species ◦ Q fever ◦ Chlamydia ◦ Bartonella ◦ Legionella Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 10. 1. Blood culture 2. Echo ◦ TTE ◦ TOE 1. FBC/ESR/CRP 2. Rheumatoid Factor 3. MSU Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 11. No prior antibiotic Aseptic technique Sterile container ( Blood culture bottles) 3 specimens of blood at an interval of 30 min Immediate transport or in case of delay must be incubated and not refrigerated Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 12. Method Advantages Disadvantages Manual • cost effective • Easily available •Time consuming • Requires manpower material • Require more blood sample •Results available after alternate days •Final results on 3rd day Automated • Results can be obtained within 7-8 hours • Requires less blood sample • Costly Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 13. Blood culture bottles for automated method Biphasic Blood culture bottles for manual Blood culture bottles for manual Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 14. 5-7% of patients with endocarditis will have sterile blood cultures 1 Year study from France ◦ 44 of 88 cases of CNE, negative cultures were associated with prior administration of antibiotics Fasidious or non-culturable organism Non-infective endocarditis Withhold empirical therapy until cultures drawn Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 15. Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 16. THANK YOU Mohammad Mukhit Kazi, Lecturer SDCH Pune
- 17. Any question please ??? Mohammad Mukhit Kazi, Lecturer SDCH Pune