Infective Endocarditis

Assessment

• Blood cultures
  • Take blood cultures before starting antibiotic therapy
  • Take at least 3 sets of blood cultures (take 2 sets immediately and take the third set at least 1 hour later¹)
  • Blood cultures should ideally be taken from 3 separate venipuncture sites to avoid any misdiagnosis
• Arrange an echocardiogram for patients with suspected infective endocarditis
  • TOEs are significantly more sensitive in the diagnosis of infective endocarditis than TTE
  • TOEs are particularly more sensitive for prosthetic valve and cardiac implantable electronic device associated endocarditis

Management

• Early involvement of cardiologist, infectious disease physician and cardiac surgeon
• Empirical antibiotic therapy
  • Standard regimen for native valve infective endocarditis
    • Benzylpenicillin 1.8 g intravensouly, 4-hourly (or if MRSA suspected, use vancomycin) and
    • Flucloxacillin 2 g intravenously 4-hourly and
    • Gentamicin intravenously
  • Standard regimen for prosthetic valve infective endocarditis
    • Vancomycin intravenously and
    • Flucloxacillin 2 g intravenously, 4-hourly
    • Gentamicin intravenosuly

Prevention

• A sample of valve tissue should be taken for culture at the time of valve surgery for endocarditis
  • If positive or if culture was not obtained, give postoperative antibiotic treatment for 4-6 weeks
  • If negative give postoperative antibiotic treatment for the recommended duration or at least 2 weeks, which is longer

Footnotes

1. In patients with sepsis or septic shock, all 3 sets of blood cultures should ideally be taken over a short time period before starting antibiotics ↩