REBEL Core Cast 27.0 – February 12, 2020 - By Anand Swaminathan
"Take-Home Points
- Endocarditis can have vague and varied presentations and has high morbidity and mortality. Be on the lookout in patients with risk factors including:
- Congenital heart disease
- Cardiac prosthesis or devices
- Immunocompromise
- IV drug use
- Recent invasive procedure
- Hx of prior IE
- Patients may present with fever, sepsis of unclear source or may have manifestations of emboli to the skin, eyes, brain, lungs, spleen or kidney.
- Diagnosis is based on the modified Duke Criteria and workup should include THREE good sets of blood cultures.
- ED management includes consultation with ID and cardiothoracic surgery and starting antibiotics based on whether the patient has a native or prosthetic valve. Basic starting antibiotic regimen includes:
- For patients with native valve disease a good starting regimen is:
- Vancomycin 25-30 mg/kg IV loading dose followed by 15-20 mg/kg twice daily AND
- Cefepime 2 g IV TID
- For patients with prosthetic valve disease, we have to go a bit bigger:
- Vancomycin 25-30 mg/kg IV loading dose followed by 15-20 mg/kg IV twice daily AND
- Rifampin 300 mg PO/IV TID AND
- Gentamicin 1 mg/kg IV TID AND
- Some recommendations include the Cefepime 2 g IV TID"