tailieunhanh - Chapter 118. Infective Endocarditis (Part 6)

The roles of bacteremia and echocardiographic findings in the diagnosis of endocarditis are appropriately emphasized in the Duke criteria. The requirement for multiple positive blood cultures over time is consistent with the continuous low-density bacteremia characteristic of endocarditis (≤100 organisms/mL). Among patients with untreated endocarditis who ultimately have a positive blood culture, 95% of all blood cultures are positive; in 98% of these cases, one of the initial two sets of cultures yields the microorganism. The diagnostic criteria attach significance to the species of organism isolated from blood cultures. . | Chapter 118. Infective Endocarditis Part 6 The roles of bacteremia and echocardiographic findings in the diagnosis of endocarditis are appropriately emphasized in the Duke criteria. The requirement for multiple positive blood cultures over time is consistent with the continuous low-density bacteremia characteristic of endocarditis 100 organisms mL . Among patients with untreated endocarditis who ultimately have a positive blood culture 95 of all blood cultures are positive in 98 of these cases one of the initial two sets of cultures yields the microorganism. The diagnostic criteria attach significance to the species of organism isolated from blood cultures. To fulfill a major criterion the isolation of an organism that causes both endocarditis and bacteremia in the absence of endocarditis . S. aureus enterococci must take place repeatedly . persistent bacteremia and in the absence of a primary focus of infection. Organisms that rarely cause endocarditis but commonly contaminate blood cultures . diphtheroids CoNS must be isolated repeatedly if their isolation is to serve as a major criterion. Blood Cultures Isolation of the causative microorganism from blood cultures is critical not only for diagnosis but also for determination of antimicrobial susceptibility and planning of treatment. In the absence of prior antibiotic therapy three blood culture sets with two bottles per set separated from each other by at least 1 h should be obtained from different venipuncture sites over 24 h. If the cultures remain negative after 48-72 h two or three additional blood culture sets should be obtained and the laboratory should be consulted for advice regarding optimal culture techniques. Empirical antimicrobial therapy should not be administered initially to hemodynamically stable patients with subacute endocarditis especially those who have received antibiotics within the preceding 2 weeks thus if necessary additional blood culture sets can be obtained without the .

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