Endocarditis

Question 1

What are the major modified Duke criteria?

Answer 1

1. 2 separate positive blood cultures with microorganisms typical for infective endocarditis (Viridans strep, strep bovis, HACEK, staph aureus, enterococci).
2. Echocardiographic evidence of endocardial involvement.
3. New valvular regurgitation.

Question 2

What are the minor modified Duke Criteria?

Answer 2

1. Predisposition: predisposing heart condition or IV drug use.
2. Temp greater than 38.
3. Vascular phenomena e.g. Janeway lesions.
4. Immunological phenomena e.g. Osler nodes.
5. Positive blood culture but not meeting major criterion, or serologic evidence of active infection with organism consistent with infective endocarditis.

Question 3

What is the empirical treatment for native valve endocarditis?

Answer 3

Amoxicillin and gentamicin IV.

Question 4

What is the empirical treatment for prosthetic valve endocarditis?

Answer 4

Vancomycin and gentamicin IV, add in rifampicin PO day 3 to 5. Often valve replacement required.

Question 5

What is the empirical treatment for drug user endocarditis?

Answer 5

Flucloxacillin IV.

Question 6

What is the treatment for staph aureus endocarditis?

Answer 6

Flucloxacillin IV.

Question 7

What is the treatment for viridans strep endocarditis?

Answer 7

Benzylpenicillin and gentamicin IV.

Question 8

What is the treatment for enterococcus sp endocarditis?

Answer 8

Amoxicillin/vancomycin and gentamicin IV.

Question 9

What is the treatment for staph epidermidis endocarditis?

Answer 9

Vancomycin and gentamicin IV, add in rifampicin PO day 3 to 5.

Question 10

How many major and minor duke criteria are needed to diagnose endocarditis?

Answer 10

2 major, or 1 major and 3 minor, or all 5 minor.