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