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ISKANDER AL-GITHMI, MD, FRCSCConsultant Cardiothoracic Surgon

Assistant !ro"ssor o" Surgr#King A$dula%i% &ni'rsit#

CHALLENGING ISSUES IN INFECTIVECHALLENGING ISSUES IN INFECTIVE

ENDOCARDITISENDOCARDITIS

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It is of use, from time to time, to take stock, so to speak of

our knowledge of a particular disease, to see exactly

where we stand in regards to it, to inquire to what

conclusion the accumulated facts seem to point and to

ascertain in what direction we may look for fruitful

investigation in the future.I propose to do this in thecase of that most interesting disease known as ulcerative

endocarditis.

Endocarditis MilestonesEndocarditis Milestones

1885 !linical syndrome" descri#ed #y $ir %illiam

&sler.

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1'(( )enicillin *+lexander leming-

1'81 on /eyn !riteria 0)ersistant #acteremia, ew

regurgitant murmur and vascular !omplications2

1''( 3uke4s !riteria proposed #y 3r. 3urack from

3uke niversity.

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ac!"ro#ndac!"ro#nd

3espite improvement in health care and advancement in

diagnostic technology and therapy" the incidence of

infective endocarditis has not decreased over the past

decades.

)rogressive evolution in risk factors6

i.e. i.v. drug use

se of prosthetic valve

7rowing resistant microorganisms.

Incidence of Infective endocarditis 15999 to :9,999 new

cases per year.

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Infective endocarditis classifications6

ative ; valve endocarditis6 associated with congenital

heart disease and chronic rheumatic heart disease.

)rostheticvalve endocarditis6

15< of individual with infective endocarditis have )=

=arly)=6 infection within >9 days of surgery

?ate )=6 infection :> months of surgery

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Infective endocarditis in intravenous drug user

!ommon in young population

@ricuspid valve involved in up to 59< of cases

)redominant pathogenes usually staph aureus

Important iatrogenic risk factors for infective

endocarditis hemodialysis

A times more frequent than in general population )redominant pathogenes is staph aureus.

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$at%o"enesis$at%o"enesis

Bacterial adherence to damaged valve6

Cechanical lesions

Inflammatory lesions

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Dia"nosis $re&re'#isiteDia"nosis $re&re'#isite

Digh index of suspicious

=arly @==6 Digh sensitivity E5'5