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1 major 1 major
Echocardiogram +: TEE recommended for prosthetic valve
majorcondition 3 minor
2Predisposing 5Possible
minor
Minor:
+1Feverminor +3 minor
>38℃
Vascular phenomena: septic emboli, pulmonary infarcts, mycotic aneurisms, Janeway lesions
Blood culture + for other potential organism
Immunologic phenomena: glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor
INFECTIVE ENDOCARDITIS
Consider:
Organism(s)
Susceptibilities (MIC)
Native or prosthetic valve
Days of therapy begin on first day of NEGATIVE blood cultures; repeat q24-48h
If valve surgery with OR cx + or perivalvular abscess: begin days of therapy after surgery
If OR cx -: then continue count from first day of negative bcx
Medication allergies
Renal/hepatic impairment
NVE HIGHLY PCN SUSCEPTIBLE (MIC ≤0.12) VGS AND S. BOVIS
A 36-year-old man with a history of intravenous drug use and NKDA is admitted to the hospital with a 1-week history
of fever and weakness and a physical examination positive for petechiae on his distal extremities. His TEE
(transesophageal echocardiogram) is positive for a 0.8-cm vegetation on his tricuspid valve, and blood cultures are
positive for Staphylococcus aureus. Susceptibilities (S) for the organism are as follows:
The patient is 71 inches tall, weighs 77 kg, and has an SCr of 0.8 mg/dL. He is given a diagnosis of uncomplicated
endocarditis. Which is the best antimicrobial regimen for this patient?
Which serum concentration target is appropriate when using gentamicin in combination with penicillin G
for a patient with viridans streptococcal endocarditis?
1. Trough of 3–5 mcg/mL (SI 6.3–10.5 µmol/mL)
2. Trough of 15–20 mcg/mL (SI 31.4–41.8 µmol/mL)
3. Peak of 3–5 mcg/mL (SI 6.3–10.5 µmol/mL)
4. Peak of 8–12 mcg/mL (SI 16.7–25.1 µmol/mL)
REFERENCES
Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy,
and Management of Complications. Circulation. 2015 Oct 13;132(15):1435-86. doi: 10.1161