Infective Endocarditis Medical Slides

Use a two-column visual: Major criteria (2 separate positive blood cultures with typical organisms OR positive echo showing vegetation/abscess/new dehiscence OR new valvular regurgitation) and Minor criteria (predisposing condition, fever >38°C, vascular phenomena, immunologic phenomena, supportive microbiology). Definite IE = 2 major, 1 major + 3 minor, or 5 minor. Note the 2023 ESC update adding FDG-PET/CT and cardiac CT as major criteria.

Emphasize obtaining 3 sets of blood cultures from separate venipuncture sites before antibiotics, with at least 1 hour between first and last set. Each set should include an aerobic and anaerobic bottle with 10 mL per bottle. Highlight that continuous bacteremia in IE means timing relative to fever spikes does not matter (unlike transient bacteremia). For culture-negative IE, discuss serologies for Coxiella burnetii, Bartonella, Brucella, and Tropheryma whipplei.

Present the 2023 ESC Class I surgical indications: (1) heart failure from severe valve regurgitation or obstruction, (2) uncontrolled infection (abscess, enlarging vegetation on appropriate antibiotics, fungal IE), (3) prevention of embolism (vegetation >10 mm after embolic event, or >15 mm in isolation). Reference the randomized trial by Kang et al. showing early surgery within 48 hours reduced the composite of death and embolic events in left-sided IE with large vegetations.