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InfectiveEndocarditisDIAGNOSIS & TREATMENT

ESC 2009 GUIDELINES

Bambang Widyantoro

2 Desember 2014

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1.1. DefnitionsDefnitions, general inormation, general inormation, pathophysiology, pathophysiology

2" C#inica# s$!tos

%" Dianosis

'" D()e criteria

2" *#ood c(#t(res

%" Ec+ocardiora!+$

,"  Treatent -asics." Co!#ications

/" ro!+$#a1is

" S(ar$

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De3nitions4 enera#

inforation

Infective endocarditisInfective endocarditis

in5aator$ !rocess on6oin insideendocardi(

d(e to infection after endot+e#i( daae

ost often invo#vin aortic and itra# va#ves

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at+oenesis

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De3nitions4 enera# inforation

 6 contin(ed

Acordin to #oca#isationAcordin to #oca#isation

Left sided IE

Native va#ve IE 7N8E

rost+etic va#ve IE78E

Ear#$ : ' $ear after s(rer$

Late ;' $ear after s(rer$

Ri+t sided IE

Device6 re#ated IE 7ICD

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De3nitions4 enera# inforation

 6 contin(ed

AAcordin to t+e ode of ac<(isitioncordin to t+e ode of ac<(isition

=ea#t+6care associated IE

Nosocoia#

Non6nosocoia#

Co(nit$ ac<(ired IE

Intraveno(s dr( a-(se6associated IE

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De3nitions4 enera# inforation

6 contin(ed

Active IE

Rec(rrence

Re#a!se

Reinfection

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De3nitions4 enera# inforation

6 contin(ed

%6'0>'00 000>$ear

Ma1i( at t+e ae of 06?0More coon in @oen

Staphylococcus aureus is t+e ost

coon !at+oen Streptococcal IE is sti## t+e ost coon

in deve#o!in co(ntries

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'" De3nitions4 enera# inforation

2.2. Clinical symptomsClinical symptoms

%" Dianosis

'" D()e criteria

2" *#ood c(#t(res

%" Ec+ocardiora!+$

,"  Treatent -asics." Co!#ications

/" ro!+$#a1is

" S(ar$

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C#inica# s$!tos

Fever  over 90B of !atients

Ne@ intra6cardiac (r(r 6 a-o(t?.B of !atients

Rot+ s!ots4 !etec+iae4#oer(#one!+ritis (! to %0B of

!atients

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C#inica# s$!tos @+en to

s(s!ect

Se!sis of (n)no@n oriin

ever coe1sistin @it+

Intracardiac i!#anta-#e ateria#

 IE +istor$

Conenita# +eart disease or va#ve disease

IE ris) factors

Conestive +eart fai#(re s$!tos

Ne@ +eart -#oc)

ositive -#ood c(#t(res

oca# ne(ro#oica# sins @it+o(t )no@n aetio#o$

erifera# a-scesess 7)idne$4 s!#een4 -rain4 verte-ra# co#(n

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'" De3nitions

2" C#inica# s$!tos

%" Dianosis

1.1. Duke criteriaDuke criteria

2" *#ood c(#t(res

%" Ec+ocardiora!+$

,"  Treatent -asics." Co!#ications

/" ro!+$#a1is

" S(ar$

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D()e criteria

MaFor criteria

'" *#ood c(#t(re !ositive for t$!ica#

IE6ca(sin icrooranis

2" Evidence of endocardia#invo#veent

Minor criteria

'" redis!osition +eart

condition or i"v" dr( a-(se2" ever te!" ;%? C

%" 8asc(#ar !+enoena arteria# e-o#i etc"

," I(no#oic !+enoena

#oer(#one!+ritis4 Os#erHsnodes4 Rot+Hs s!ots

." Micro-io#oica# evidence !ositive -#ood c(#t(res -(tdo not eet aFor criteria

Dianosis• 2 aFor criteria• ' aFor and % inor• . inor criteria

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'" De3nitions

2" C#inica# s$!tos

%" Dianosis

'" D()e criteria

2.2. Blood culturesBlood cultures

%" Ec+ocardiora!+$

,"  Treatent -asics." Co!#ications

/" ro!+$#a1is

" S(ar$

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*#ood c(#t(res

A#@a$s -efore startin anti-iotics

A#@a$s tri!#e sa!#es aero-e4 anaero-e and $cotic 4 '0 #eac+

 T+ree sets of sa!#es re<(ired

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'" De3nitions

2" C#inica# s$!tos

%" Dianosis

'" D()e criteria

2" *#ood c(#t(res

3.3. chocardiographychocardiography

,"  Treatent -asics." Co!#ications

/" ro!+$#a1is

" S(ar$

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Ec+ocardiora!+$

 Transt+oracic 7TTE and transoeso!+aea# 7TEE

f(ndaenta# i!ortance in dianosis4anaeent4 and fo##o@6(!

S+o(#d -e !erfored as soon as t+e IE iss(s!ected

Sensitivit$ of TEE is -ier t+an TTE 7vs 906'00Bvs" ,06/%B

 TEE is 3rst c+oice to 3nd IE co!#ications

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Ec+ocardiora!+$

Ec+ocardiora!+ic 3ndins in IEEc+ocardiora!+ic 3ndins in IE

8eetation A-scess

se(doane(r$s

erforation

ist(#a 8a#ve ane(r$s

Dis+ence of !rost+etic va#ve

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'" De3nitions

2" C#inica# s$!tos

%" Dianosis

'" D()e criteria

2" *#ood c(#t(res

%" Ec+ocardiora!+$

!.!. "reatment #asics"reatment #asics." Co!#ications

/" ro!+$#a1is

" S(ar$

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 Treatent -asics

S(cess re#ies on eradication of !at+oen

*actericida# reient s+o(#d -e (sed

Dr( c+oice d(e to !at+oen

S(rer$ is (sed ain#$ to co!e @it+ str(ct(ra#co!#ications

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 Treatent -asics 6 contin(ed

N8E standard t+era!$ 6 it ta)es 26/ @ee)s toeradicate t+e !at+oen

8E #oner reie is necesser$ over / @ee)s

In Stre!tococca# IE s+orter4 2 @ee) co(rse4 can-e (sed @+en co-inin 6#a)tas @it+aino#$cosides

Most @ide#$ (sed dr(s ao1$c$#in4 enta$cin

In case of 6#a)tas a#er$ 6 vanco$cin

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'" De3nitions

2" C#inica# s$!tos

%" Dianosis

'" D()e criteria

2" *#ood c(#t(res

%" Ec+ocardiora!+$

,"  Treatent -asics$.$. ComplicationsComplications

/" ro!+$#a1is

" S(ar$

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Co!#ications

'"'" Conestive +eart fai#(reConestive +eart fai#(re

• Most coon co!#ication

• Main indication to s(rica# treatent

• J/0B of IE !atients

2"2" Uncontro##ed infectionUncontro##ed infection

• ersistin infection

• eriva#v(#ar e1tension in infective endocarditis

%"%" S$steic e-o#isS$steic e-o#is• *rain4 s!#een and #(ns

• %0B of IE !atients

• Ma$ -e t+e 3rst s$!to

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Co!#ications 6 contin(ed

."." Ne(ro#oic eventsNe(ro#oic events

/"/" Ac(te rena# fai#(reAc(te rena# fai#(re"" R+e(atic !ro-#esR+e(atic !ro-#es

?"?" M$ocarditisM$ocarditis

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'" De3nitions

2" C#inica# s$!tos

%" Dianosis

'" D()e criteria

2" *#ood c(#t(res

%" Ec+ocardiora!+$

,"  Treatent -asics." Co!#ications

%.%. &rophyla'is&rophyla'is

" S(ar$

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ro!+$#a1is

irst and ost i!ortant proper oral hygieneproper oral hygiene

(egular(egular dental revie)dental revie)

Anti-iotics on#$ in +i+6ris) ro(! !atients

rost+etic va#ve or forein ateria# (sed for +eartre!air

=istor$ of IE

Conenita# +eart disease

C$anotic @it+o(t correction or @it+ resid(a# #ic)eae

C=D @it+o(t #ic)eae -(t (! to / ont+s after s(rer$

Use ao1$ci#in or a!ic$#in %06/0 in !rior tointervention

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'" De3nitions

2" C#inica# s$!tos

%" Dianosis

'" D()e criteria

2" *#ood c(#t(res

%" Ec+ocardiora!+$

,"  Treatent -asics." Co!#ications

/" ro!+$#a1is

*.*. +ummary+ummary

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S(ar$

'" IE is rare -(t serio(s disease4 @it+ +i+ orta#it$ rate

2" Ever$ case of fever of (n)no@n oriin s+o(#d -e

s(s!ected for IE

%" *#ood c(#t(res are essentia# for dianosis

,"  TTE>TEE is t+e -est et+od to onitor and fo##o@6(!of IE

." Anti-iotics are ain treatent

/" C= is t+e ost coon co!#ication

" +araco#oica# !ro!+$#a1is is reserved for a narro@ro(! of +i+ ris) !atients

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