The power point is all about Blood culture negative Infective Endocarditis prepared by Dr Julieth Nachone Kabirigi, a Pediatric Cardiologist and a Lecturer at Catholic University.
These slides aiming to help other to understand the importance of history taking, multidisciplinary approach and various diversity on diagnosis and management of Infective Endocarditis especially in children
2. OUTLINE
• Introduction of Infective Endocarditis (IE)
• Epidemiology
• Pathogenesis
• Overview of BCNIE
• Treatment BCNIE
• Challenges
• Take home
•
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3. INTRODUCTION
• Infective endocarditis is defined by
infection of a native or prosthetic cardiac
valve, the endocardial surface
• Annual incidence of about 2–12 cases per
100 000 people
• In hospital mortality rate is 20% and 40%
at 5years
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10. OVERVIEW BCNIE
• Most cases of endocarditis are caused by bacterial infection;
usually, the diagnosis is made by culture-dependent methods
and imaging
• Uncertainty about the causative organism may result in
a) Inadequate treatment
b)Exposure of the patient to potentially toxic empirical
treatment, and ultimately affect the outcome
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11. EPIDEMIOLOGY
• BCNIE can occur in up to 31% of all cases of IE
and often poses considerable diagnostic and
therapeutic dilemmas.
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12. DEFINITION
• Blood culture-negative IE (BCNIE) refers to IE
in which no causative microorganism can be
grown using the usual blood culture methods
• Associated with severe illness and death
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13. CAUSES OF BCNIE
Administration of antimicrobial agents before blood culture.
• Fastidious microorganisms in which prolonged incubation is
necessary.
• Intracellular bacteria that cannot be detected by the currently
available routine blood culture system
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18. Microbiology: Blood Cultures
• 1–3 mL in infants and young children and 5–7 mL in
older children are optimal
• Blood cultures should be drawn for patients with fever of
unexplained origin and a pathological heart murmur,
(Class I; Level of Evidence B).
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19. • It is reasonable to obtain 3 blood cultures by separate venipunctures
on the first day, and if there is no growth by the second day of
incubation, to obtain 2 or 3 more (Class IIa; Level of Evidence B).
• In patients who are not acutely ill and whose blood cultures remain
negative, withholding antibiotic drugs for ≥48 hours while additional
blood cultures are obtained may be considered to determine the
cause of IE (Class IIb; Level of Evidence C).
• In patients with acute IE who are severely ill and unstable, 3
separate venipunctures for blood cultures should be performed over
a short period such as 1 to 2 hours and empirical antibiotic therapy
initiated (Class I; Level of Evidence C).
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20. • If fastidious or unusual organisms are suspected, the
director of the microbiology laboratory or a consultant in
pediatric infectious diseases should be consulted for help in
diagnosis and especially for guidance on molecular
pathogen identification and when use of serological testing
is likely to be beneficial (Class I; Level of Evidence C).
• Culture of arterial blood is not more useful than
venipuncture because it does not increase yield over
venous blood cultures (Class III, No Benefit; Level of
Evidence B).
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24. Emerging challenges in IE
1) The emergence of antimicrobial resistance in classic
IE microflora
2) The existence of antimicrobial resistance in complex
ecologic biofilms
3) The changing pattern of causal agents now regarded
as important pathogens of infective endocarditis, e.g.
Bartonella spp., T. whippelii and fungi
4) Changing epidemiologic trends of persons who
acquire IE, including IDU, persons with HIV/AIDS
5) Diagnostic methods
6) Late presentation
25. TAKE HOME MESSAGE
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Management of endocarditis
with a multidisciplinary
endocarditis team improves
outcomes through
individualized care and early
surgery.
