Endocarditis complications

The ICU team today discussed the complications of endocarditis in a very challenging case. Let’s review briefly.

Infectious Endocarditis (IE) complications:

Prevalence: Most studies looking at this are retrospective, but at least 1 complication of IE was seen in 57% of patients with this disease, 2 complications in 26%, and 8% with 3+!

Complications by organ system

Neuro: Septic emboli (can be seen in any organ with metastatic infection — lung, spleen, kidney major sites as well), mycotic aneurysm (any organ susceptible, happens more often at vessel bifurcations), meningitis, cerebral hemorrhage (2/2 mycotic aneurysm rupture).

Cardiac: Heart failure (most common cause of death in IE, more commonly seen w/ aortic involvement), perivalvular abscess (TEE more sensitive for this dx), pericarditis (suppurative or nonsuppurative), intra-cardiac fistula.

Renal: Glomerulonephritis, drug induced AIN from abx

MSK: Psoas muscle abscesses, osteomyelitis, discitis, septic arthritis

Briefly on purulent myocarditis/pericarditis: Staph aureus is most common infectious cause, but strep, salmonella (remember the association w/ mycotic aneurism!), candida, and TB can also do it. Usually very poor outcomes, but pericardial drainage and antibiotics are mainstays of tx.

 

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