TAILIEUCHUNG - Chapter 118. Infective Endocarditis (Part 12)

Antibiotic Therapy after Cardiac Surgery Bacteria visible in Gram-stained preparations of excised valves do not necessarily indicate a failure of antibiotic therapy. Organisms have been detected on Gram's stain—or their DNA has been detected by PCR—in excised valves from 45% of patients who have successfully completed the recommended therapy for endocarditis. In only 7% of these patients are the organisms, most of which are unusual and antibiotic resistant, cultured from the valve. Despite the detection of organisms or their DNA, relapse of endocarditis after surgery is uncommon. Thus, for uncomplicated native valve infection caused by susceptible organisms in conjunction. | Chapter 118. Infective Endocarditis Part 12 Antibiotic Therapy after Cardiac Surgery Bacteria visible in Gram-stained preparations of excised valves do not necessarily indicate a failure of antibiotic therapy. Organisms have been detected on Gram s stain or their DNA has been detected by PCR in excised valves from 45 of patients who have successfully completed the recommended therapy for endocarditis. In only 7 of these patients are the organisms most of which are unusual and antibiotic resistant cultured from the valve. Despite the detection of organisms or their DNA relapse of endocarditis after surgery is uncommon. Thus for uncomplicated native valve infection caused by susceptible organisms in conjunction with negative valve cultures the duration of preoperative plus postoperative treatment should equal the total duration of recommended therapy with 2 weeks of treatment administered after surgery. For endocarditis complicated by paravalvular abscess partially treated prosthetic valve infection or cases with culture-positive valves a full course of therapy should be given postoperatively. Extracardiac Complications Splenic abscess develops in 3-5 of patients with endocarditis. Effective therapy requires either image-guided percutaneous drainage or splenectomy. Mycotic aneurysms occur in 2-15 of endocarditis patients half of these cases involve the cerebral arteries and present as headaches focal neurologic symptoms or hemorrhage. Cerebral aneurysms should be monitored by angiography. Some will resolve with effective antimicrobial therapy but those that persist enlarge or leak should be treated surgically if possible. Extracerebral aneurysms present as local pain a mass local ischemia or bleeding these aneurysms are treated by resection. Intracardiac Surgical Indications Most surgical interventions are warranted by intracardiac findings detected most reliably by TEE. Because of the highly invasive nature of prosthetic valve endocarditis as many as 40 of affected

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