- Provide supplemental oxygen at 2 to 4 L/min to maintain or improve oxygenation.
- Minimize oxygen demand to decrease anxiety.
- Maintain patient on bed rest if in acute hear failure.
- Administer multi-I.V. antibiotic regimen as ordered.
- Administer antipyretics as ordered and as needed.
Medication
Infective endocarditis is a potentially lethal disease and requires prolonged antibiotic therapy. The aim of antibiotic therapy is to eradicate infection which includes sterilization of the vegetations.
Procedures
[Level 5] Empirical antibiotic therapy is recommended if the suspicion of endocarditis is high; once culture results are obtained, the antibiotic selection can target the sensitivity of the organism.
Nutrition
Tests used to confirm or rule out endocarditis include: Blood culture test. A blood culture test is used to identify any germs in your bloodstream. Blood culture test results help your doctor choose the most appropriate antibiotic or combination of antibiotics.
What are the treatment options for infective endocarditis?
Finally, the decision of whether or not to operate early in infective endocarditis is always difficult and remains specific for the individual patient. The benefit of surgery must be weighed against the operative risk and take into account the clinical status of the patient and the co‐morbidities.
When is empirical antibiotic therapy indicated in the treatment of endocarditis?
What tests are used to rule out endocarditis?
Should we operate early in infective endocarditis?
What is the nursing management of endocarditis?
Nursing Care Plan for Endocarditis 1Endocarditis Nursing InterventionsRationalesOffer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.3 more rows
What is the first line treatment for endocarditis?
First-line treatment: Cefepime 2 g IV q8h for normal renal function. Second-line treatment (if patient is penicillin or cephalosporin intolerant): Aztreonam 2 g IV q8h for normal renal function. Antipseudomonal penicillin plus aminoglycoside recommended if Pseudomonas aeruginosa endocarditis is suspected.
What is your treatment of choice for bacterial endocarditis?
Treatment with aqueous penicillin or ceftriaxone is effective for most infections caused by streptococci. A combination of penicillin or ampicillin with gentamicin is appropriate for endocarditis caused by enterococci that are not highly resistant to penicillin.
What are the goals of pharmacotherapy for infective endocarditis?
The major goals of therapy for infective endocarditis (IE) are to eradicate the infectious agent from the thrombus and to address the complications of valvular infection. The latter includes both the intracardiac and extracardiac consequences of IE. Some of the effects of IE require surgical intervention.
What is the treatment for heart infection?
Depending on the type of heart infection, treatments may include: Antifungal medications. Antibiotics. Colchicine (an anti-inflammatory medication).
Can endocarditis be treated with oral antibiotics?
Patients with endocarditis caused by common bacteria can be treated effectively and safely with oral antibiotics once they have been stabilized on an intravenous course of therapy, data from the POET trial suggest.
What antibiotics treat endocarditis prophylaxis?
Antibiotic regimens for endocarditis prophylaxis are directed toward S viridans, and the recommended standard prophylactic regimen is a single dose of oral amoxicillin.
When should I take gentamicin for endocarditis?
Occasionally, bacterial endocarditis is caused by viridans streptococci that are moderately susceptible to penicillin. These patients should be treated with intravenous penicillin at a dosage of 18 million units every 24 hours for four weeks and with gentamicin for the first two weeks.
What is the drug of choice for the prevention of infective endocarditis chosen by the American Heart Association?
Intravenously administered vancomycin is the drug of choice in patients who are unable to take oral antibiotics or who are known to have methicillin-resistant Staphylococcus aureus bacteremia.
What are the clinical manifestations of infective endocarditis?
Fever and chills are the most common symptoms; anorexia, weight loss, malaise, headache, myalgias, night sweats, shortness of breath, cough, and joint pains are common problems as well. Primary cardiac disease may present with signs of congestive heart failure caused by valvular insufficiency.
Why is gentamicin added in endocarditis?
Synergy is needed with an aminoglycoside in order to achieve a bactericidal effect because most cell-wall active drugs are only considered bacteriostatic against enterococci. Of the two aminoglycosides used to treat enterococcal endocarditis, gentamicin is primarily used unless resistance is present.
What is the pathophysiology of endocarditis?
The pathophysiology of infective endocarditis comprises at least three critical elements: preparation of the cardiac valve for bacterial adherence, adhesion of circulating bacteria to the prepared valvular surface, and survival of the adherent bacteria on the surface, with propagation of the infected vegetatlon.
How long does endocarditis last after a transcatheter?
Congenital heart disease that is completely repaired by surgery or with a transcatheter device. Endocarditis prevention is reasonable for at least 6 months following the device implant.
How to tell if you have bacterial endocarditis?
Sometimes doctors insert an ultrasound probe into the esophagus or “food pipe” (transesophageal echo) to obtain a closer more detailed look at the heart. Other signs and symptoms of bacterial endocarditis include: Emboli (small blood clots), hemorrhages (internal bleeding), or stroke. Shortness of breath. Night sweats.
What is the purpose of the American Heart Association review of the scientific literature?
The American Heart Association conducted a review of the scientific literature to determine the value and effectiveness of antibiotic prophylaxis (preventive antibiotics) before such procedures in reducing the risk of bacterial endocarditis.
Can endocarditis be prevented?
Not all endocarditis can be prevented. Call your doctor if you have symptoms of an infection (See signs of infection listed above). Do not wait a few days until you have a major infection to seek treatment. Colds and the flu do not cause endocarditis.
Can you take antibiotics for valve disease?
Dental procedures (particularly tooth extractions) and endoscopic examinations are associated with bacteria in the blood, so prophylactic (preventative) antibiotics are advised for some patients with valve disease and all patients with valve replacements. Intravenous drug abusers are at high risk for developing IE.
Can you take antibiotics for endocarditis?
To be safe, call your doctor. Only the people who have the highest risk for bacterial endocarditis will reasonably benefit from taking preventive antibiotics before certain procedures.
Is endocarditis a result of bacteria?
Summary of Infective Endocarditis (IE) Prevention Guidelines from the American Heart Association*. Endocarditis is more likely a result of daily exposure to bacteria, rather than exposure during a dental, gastrointestinal tract or genitourinary tract procedure.
What is the best treatment for endocarditis?
Linezolid and daptomycin are two drugs useful in resistant enterococcal endocarditis. Fluoroquinolones are another group of drugs considered in the treatment of susceptible strains of staphylococci and HACEK group of organisms.
What is the treatment for infective endocarditis?
Treatment of infective endocarditis. Infective endocarditis is a potentially lethal disease and requires prolonged antibiotic therapy. The aim of antibiotic therapy is to eradicate infection which includes sterilization of the vegetations. But there are certain challenges in the sterilization of vegetations.
Why is treatment of infective endocarditis often empirical in the initial phase?
Treatment of infective endocarditis is often empirical in the initial phase because of delay in getting appropriate culture and sensitivity reports. Choice of antibiotics depend on the clinical scenario in which endocarditis has occurred. Important factors include injection drug abuse, ...
Why are bactericidal drugs needed?
Need for bactericidal drugs. Bactericidal drugs are needed to sterilize the vegetations of infective endocarditis which have high microbial density . Combination of β-lactams with aminoglycosides is useful in this context. Sometimes bactericidal effect can be obtained by the synergistic effect of bacteriostatic drugs.
How long does ceftriaxone last?
In the presence of a prosthetic valve or prosthetic valve material, duration of therapy is 6 weeks. Staphylococcus aureus is now the most common causative organism for infective endocarditis in most of the industrialized nations [1]. This has been primarily attributed ...
How long does it take to cure prosthetic valve endocarditis?
Prosthetic valve endocarditis. Duration of treatment for prosthetic valve endocarditis is 6 weeks or more. Rifampicin is an important drug in this situation. For oxacillin-susceptible strains of staphylococci, rifampicin and oxacillin for a minimum of 6 weeks along with gentamicin for initial 2 weeks are recommended.
How long should you repeat a blood culture?
It has been suggested that if positive blood cultures are obtained, repeat cultures at 24-48 hour intervals be taken to document clearance of organisms from the blood stream. Counting of duration of antibiotic therapy may be from the day on which it becomes negative when it was positive initially [1].
What is the best way to alert healthcare providers about endocarditis?
Carry a wallet card that says you are at risk for endocarditis. This card will alert healthcare providers. It will also help them decide if you need antibiotics before a procedure or in an emergency. You can get this card through the American Heart Association.
How to tell if you have endocarditis?
Always tell your dentist that you have had endocarditis. Ask your healthcare provider if you should take antibiotics before certain procedures. Some procedures may allow bacteria to get into your blood and travel to your heart. Carry a wallet card that says you are at risk for endocarditis.
What is the infection of the inner lining of the heart?
WHAT YOU NEED TO KNOW: Endocarditis is an infection of the inner lining of your heart. It may also affect the valves of your heart. Endocarditis, and the health problems it may cause, can be serious and can become life-threatening.
How to prevent germs from spreading?
Prevent the spread of germs: Wash your hands often. Wash your hands several times each day. Wash after you use the bathroom, change a child's diaper, and before you prepare or eat food. Use soap and water every time. Rub your soapy hands together, lacing your fingers.
How do antibiotics treat bacterial infections?
Antibiotics treat a bacterial infection. Antifungals treat a fungal infection. Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him of her if you are allergic to any medicine.
The recommendations and levels of evidence are defined as
Level 1: Class I recommendations are derived from meta-analysis and multiple randomized controlled trials. Level II: Class I recommendations are derived from a single randomized controlled trial or multiple non-randomized clinical trials. Level III: Class I recommendations are derived from case reports, expert opinions, or standard of care.
General Infective Endocarditis Treatment Guidelines Recommendations
Obtain infectious diseases consultation before initiating antimicrobial therapy to define an optimal empirical treatment regimen.
Likely causative organisms in patients with risk factors
It is very important to suspect the possible organisms in specific risk groups. This is especially helpful when an empiric treatment regimen is initiated as in cases of culture-negative infective endocarditis or when the reports of blood cultures are awaited.
Infective Endocarditis Treatment Guidelines
The treatment dose, recommended first and second-line drugs with doses of each microorganism are given in this section. It covers the following subtopics:
Recommendations
Drug Nafcillin or oxacillin Dose 12 g/24 h IV in 4–6 equally divided doses Duration 6 weeks Comments For complicated right-sided IE and left-sided IE; for uncomplicated right-sided IE, 2 wk.
Recommendations
Drug: Nafcillin or oxacillin PLUS Rifampin PLUS Gentamicin Dose: Nafcillin/Oxacillin dose: 12 g/24 h IV in 6 equally divided doses Rifampin dose: 900 mg per 24 h IV or orally in 3 equally divided doses Gentamicin dose: 3 mg/kg per 24 h IV or IM in 2 or 3 equally divided doses Duration: Nafcillin/ Oxacillin: ≥6 weeks Rifampin: ≥6 weeks Gentamicin: 2 weeks Comments: Vancomycin should be used in patients with immediate-type hypersensitivity reactions to β-lactam antibiotics Cefazolin may be substituted for nafcillin or oxacillin in patients with non–immediate-type hypersensitivity reactions to penicillin..
Recommendations
Drugs: Linezolid OR Daptomycin Dose: Linezolid dose: 600 mg IV or orally every 12 h Daptomycin dose: 10–12 mg/kg per dose Duration: > 6 weeks Comments: Linezolid use may be associated with potentially severe bone marrow suppression, neuropathy, and numerous drug interactions. Patients with IE caused by these strains should be treated by a care team including specialists in infectious diseases, cardiology, cardiac surgery, clinical pharmacy, and, in children, pediatrics. Cardiac valve replacement may be necessary for a cure..
