FTYKTKA: Endocarditis

Dr. David Carr February 24th 2015

I have no conflict of interest

The guy who does the cultures

•  70 y.o female diabetic unwell for 2 weeks •  Blood cultures grew strep bovis •  You call the pt: “feels ok” What next? A) Never heard of it must be contaminant B) Reassurance C) Repeat cultures send her home for the w/e D) Wikipedia it

The 5 Commandments of IE

1. Examine your febrile pts

Look for the classics

Look at their patients teeth

Physical exam new millenium

2. Know your high risk patients

IVDU + Fever = IE (15%)

Valve + Fever OR unwell= IE

3. Know what to do with BC’s

Probably a contaminant eh?

Coag neg staph + valve = IE

CNS & N valve not always a contaminant: Look for the SLUG

4. Get nervous when the bacteria does not fit the crime

5. Empiric Rx only if urgent

Sanford Guide 2013

No ER SBE prophylaxis needed

Take Home Points

•  Respect fever in all comers •  Be afraid of valves and IVDU •  Know what to do with abnormal cultures •  Be afraid of the wrong bugs in the wrong sites •  You almost never need to treat or pre treat