资源描述
Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,7/98,*,7/98,Update onInfective Endocarditis,7/98,2,Pathogenesis,Disruption of the endocardial layer as a complication of abnormal blood flow associated with underlying cardiac defect,Bacterium-endothelium interaction with bacterial attachment and invasion of endothelial cells,7/98,3,Epidemiology,Underlying valvular abnormality predisposing to infective endocarditis,rheumatic fever,a common cause in the past,mitral valve prolapse,currently represents the most common underlying cardiac abnormality,7/98,4,mitral valve prolapse,risk for infective ednocarditis is,5x-8x,mitral regurgitation increases the risk,leaflet redundancy with myxomatous degeneration is a frequent finding,age 20,male accounts for 60%age 50,male accounts for 68%,7/98,5,Mitral Valve Prolapse and Infective Endocarditis,Male,Female,Number of cases,Rev Infect Dis 1986;8:117-137,7/98,6,Coagulase-negative Staphylococci,can produce native-valve endocarditis in mitral valve prolapse,usually subacute,difficult to diagnose,and disregarded as a contaminant,delay in diagnosis and treatment may account for the severe complications,myocardial abscess formation,valvular insufficiency requiring valve surgery,death,7/98,7,Prosthetic Heart Valve,positive blood culture in hospitalized patients with underlying prosthetic valves can be a harbinger of endocarditis,43%patients with nosocomial bacteremia or fungemia had prosthetic valve infection,a serious complication,7/98,8,IV Drug Use,Recurrent,Polymicrobial,Staph aureus accounts for the majority of cases of endocarditis,tricuspid valve,either alone or in combination,us most often infected,7/98,9,Predisposing Factors,Polymicrobial Infective Endocarditis,7/98,10,Polymicrobial Infective Endocarditisclinical features,IV drug use is the predominant risk factor,younger age(mean 36.5 years),2/3 were male,right-sided cardiac involvement in 60%,streptococci more frequent than S.aureus,1/3 of patients died,mortality rate is 4x higher for pure left-sides vs pure right-sided endocarditis,7/98,11,Diagnostic(Duke)Criteria,Definitive infective endocarditis,pathologic criteria,microorganisms or pathologic lesions:demonstrated by culture or histology in a vegetation,or in a vegetation that has embolized,or in an intracardiac abscess,clinical criteria(,see below,),two major criteria,or one major and three minor criteria,or five minor criteria,7/98,12,Diagnostic(Duke)Criteria,Possible infective endocarditis,findings consistent of IE that fall short of“definite”,but not“rejected”,Rejected,firm alternate Dx for manifestation of IE,resolution ofmanifestations of IE,with antibiotic therapy for,4 days,no pathologic evidence of IE at surgery or autopsy,after antibiotic therapy for,4 days,7/98,13,Diagnostic(Duke)Criteria,Major criteria,positive blood culture for IE,evidence of endocardial involvement,Minor criteria,predisposition(heart condition or IV drug use),fever of 100.4,0,F or higher,vascular or immunologic phenomena,microbiologic or echocardiographic evidence not meeting major criteria,7/98,14,Dukes Major Criteria,positive blood culture for IE,typical microorganism(strep viridans,strep bovis,HACEK group,staph aureus or enterococci in the absence of a primary locus)for endocarditis from two separate blood cultures,persistently positive blood culture from:,blood cultures drawn more than 12 hr apart,or,all of 3 or a majority of 4 or more separate blood cultures,with first and last drqwn at least 1 hr apart,7/98,15,Dukes Major Criteria,Evidence of endocardial involvement,positive echocardiogram for endocarditis,oscillating intracardiac mass on valve or supporting structure,or in the path of regurgitant jets,or on implanted material,in the absence of an alternate anatomic explanation,abscess,new partial dehiscence of prosthetic valve,new valvular regurgitation(increase or change in pre-existing murmur not sufficient),7/98,16,Dukes Minor Criteria,predisposition(predisposing heart condition or iv drug use),fever of 100.40F or higher,vascular phenomena(major arterial emboli,septic pulmonary infarcts,mycotic aneurysm,intracranial hemorrhage,conjunctive hemorrhages,Janeway lesions),7/98,17,Dukes Minor Criteria,immunologic phenomena(glomerulonephritis,Oslers nodes,Roth spots,rheumatoid factor),microbiologic evidence(positive blood culture not meeting major criteria or serologic evidence of active infection with organism consistent with IE),echocardiogram(consistent with IE but not meeting major criteria),7/98,18,Risk for Endocarditis,High risk,prosthetic cardiac valve,prior episodes of endocarditis,complex congenital cardiac defect,surgically constructed systemic-pulmonary shunts or conduits,7/98,19,Risk for Endocarditis,Moderate risk,patent ductus arteriosus,VSD,primum ASD,coarctation of the aorta,bicuspid aortic valve,hypertrophic cardiomyopathy,acquired valvular dysfunction,MVP with mitral regurgitation,7
展开阅读全文