Endocarditis checklist Initial evaluation • Peripheral blood cultures (three sets at three different sites) • Additional culture of any indwelling line in place >48 hours • Echocardiography (TTE +/- TEE) • Chest CT scan, if suspect right-sided endocarditis w/ septic pulmonary embolization • Evaluate for metastatic infection, if suspected (e.g., spine, joints, spleen, brain) Indications for surgical consultation • Valve regurgitation or fistula causing heart failure • Myocardial abscess • Vegetation enlargement despite ABX • Persistent fever, positive cultures • Large vegetation with multiple embolic phenomena Follow course • Adjust antibiotics depending on speciation & sensitivities • Obtain single blood culture daily (until blood sterilizes) • Monitor on telemetry for heart block (+/- daily EKG) • Consider repeat echo (to r/o vegetation growth or worsening valve function) • Aggressive management of any metastatic foci of infection (e.g. septic arthritis, splenic abscess) By Dr. Josh Farkas @PulmCrit - The Internet Book of Critical Care #Endocarditis #checklist #criticalcare #diagnosis #management
