1. Infective endocarditis
treatment

2. 治療原則
• 高劑量: High dose antibiotic
• 靜脈注射:Intravenous
• 長時間: Long time (通常要2-6個星期)
• 細菌的生長(Valve與vegetation)與營養供給
皆由血流供應。

3. Acute endocarditis
• Acute endocarditis
• Empirical antibiotic
• vancomycin and ceftriaxone IV infusions
until the microbial identification

4. subacute endocarditis
• subacute endocarditis
• hemodynamic status is usually
stable, antibiotic treatment can be delayed
till the causative microorganism can be
identified.

5. • 兩大常見感染菌:
• 1.金黃色葡萄球菌(Staphylococcus aureus)
常有抗藥性，故用vancomycin
• 2.草綠色鏈球菌(Streptococcus viridans)
penicillin敏感，可用 ceftriaxone
(β-lactam antibiotics )
有抗性者，可再加 aminoglycoside
->故未知菌種時常用:
vancomycin + ceftriaxone通吃
待實驗室culture出來，可針對菌種用specific、劑量較小
的antibiotics。

6. 需要清創手術者或換瓣膜
1.瓣膜不正常者，或導致的心房、心室功能問題
‣ Patients with significant valve stenosis or
regurgitation causing heart failure
‣ Evidence of hemodynamic compromise in the
form of elevated end diastolic left ventricular or
left atrial pressure or moderate to severe
pulmonary hypertension
‣ Presence of intracardiac complications like
paravalvular abscess, conduction defects or
destructive penetrating lesions
‣ Early closure of mitral valve

7. 2.抗生素不夠力
‣ Recurrent septic emboli despite appropriate antibiotic treatment
‣ Large vegetations (> 10 mm)
‣ Persistent positive blood cultures despite appropriate antibiotic
treatment
‣ Infection caused by Fungi or resistant Gram negative bacteria
3.人工瓣膜損壞
‣ Prosthetic valve dehiscence
‣ Relapsing infection in the presence of a prosthetic valve
4.壞死
‣ Abscess formation

8. 死亡率
• Infective endocarditis is associated with
18% in-hospital mortality.
• 預後
• 常見併發症心臟衰竭，常因二尖瓣或主動
脈遭破壞。自從使用抗生素以後，預後較
好，恢復率約有65至80％。

9. 預防
• 拔牙或扁桃腺切除時，經常有暫時性的菌
血症 (bacteremia)，而且泌尿系統和消化系
統的外科手術也會造成菌血症。
• 患有風濕性心臟病或風溼性心臟病的病
孩，在手術當天和手術後兩天之內，應該
用 penicillin 預防亞急性細菌性心內膜炎。