133.3 🩺 內科專科考前版

133.3.0.1 1⃣ 2023 ESC IE Guidelines / 2024 AHA Updates

  • Outpatient parenteral antibiotic therapy (OPAT): stable patients can finish IV antibiotics outpatient
  • Oral switch (POET trial 2019, NEJM): after 7-10 d IV stable → oral antibiotics non-inferior — 改變 paradigm
  • PET-CT with FDG for prosthetic valve IE: increased Duke major criteria sensitivity

133.3.0.2 2⃣ Endocarditis Prophylaxis

133.3.0.2.1 High-risk only (2007 AHA + 2023 update)
  • Prosthetic valve / repaired
  • Previous IE
  • Congenital heart disease (unrepaired cyanotic, repaired with shunt, prosthetic material)
  • Heart transplant with valvulopathy
133.3.0.2.2 Procedures requiring prophylaxis
  • Dental: gingival manipulation, perforation of oral mucosa
  • Respiratory: incision/biopsy
  • NOT routine for: GI, GU procedures (unless infected tissue)
133.3.0.2.3 Antibiotic
  • Amoxicillin 2 g PO 30-60 min before procedure
  • 䞍胜 PO: Ampicillin/cefazolin/ceftriaxone IV
  • Penicillin allergy: Cephalexin 2g, Azithromycin 500 mg, Doxycycline 100 mg

133.3.0.3 3⃣ Culture-negative IE Workup

  • Special media: HACEK, anaerobes, fungi, mycobacteria
  • Serology: Bartonella, Coxiella (Q fever), Brucella, Legionella, Mycoplasma, Chlamydia, Aspergillus precipitins
  • PCR on excised valve tissue (16S rRNA)
  • Whipple disease (Tropheryma whipplei): PCR

133.3.0.4 4⃣ 22E 曎新

  • POET trial paradigm: oral switch (amox + rif or clinda)
  • Daptomycin for MRSA IE (high-dose 8-10 mg/kg)
  • Ceftaroline alternative for MRSA refractory
  • Cefiderocol for MDR pseudomonas IE (rare but possible in IVDU/HCAI)

133.3.0.5 5⃣ 台灣 context

  • CAIE: S. viridans, S. aureus 為䞻
  • HCAIE 增加: catheter-related, hemodialysis, cardiac devices
  • Q fever (S. coxiella): 牧區接觞, å± å®°å» 
  • Brucella: 沒未殺菌乳補品
  • TB endocarditis (rare): 結栞 endemic 區; 倚 prosthetic, immunocompromised