Risk factors for IE:
Age >60 years, male sex, injection drug use, and poor dentition or dental infection.
Comorbid conditions that confer increased risk for IE:
Structural heart disease, presence of prosthetic heart valve(s), history of infective endocarditis, presence of an intravascular device, chronic hemodialysis, and HIV infection.
Treat: 4-6 weeks of IV antibiotics starting from the time of the first NEGATVE blood culture.
- MSSA: Amoxicillin 500mg PO qd.
- MRSA: (6 weeks) Vancomycin or Daptomycin
- Prosthetic valve: Add Amp/Gent
If the patient’s repeat blood cultures are positive, then he will need a TEE, and if the TEE is positive, then the patient will require 6 weeks of IV Vancomycin.
If the patient’s repeat blood cultures are negative, then plan to discontinue Vancomycin.