298.2 🩺 國考版

298.2.1 高頻考點

298.2.1.1 Modified Duke Criteria (2023 Update)

  • Major (blood culture + endocardial involvement)
  • Minor (predisposition + fever + vascular + immunologic + microbiology)
  • Definite IE: 2 major OR 1 major + 3 minor OR 5 minor

298.2.1.2 Causative Organisms by Setting

  • Acute, aggressive: S. aureus
  • Subacute, oral: viridans Strep
  • IV drug user: S. aureus (R-sided)
  • Prosthetic: CoNS, S. aureus, fungi
  • Elderly + GI/GU: Enterococcus, S. gallolyticus
  • Culture-negative: HACEK, Bartonella, Coxiella

298.2.1.3 Strep gallolyticus = Colon Cancer Screen

  • Strong association
  • Colonoscopy + GI workup recommended

298.2.1.4 Empiric Treatment

  • NVE: vancomycin + ceftriaxone
  • IV drug user: vancomycin (MRSA cover)
  • PVE: vanc + gentamicin + rifampin

298.2.1.5 Surgery Indications (Class I)

  • HF from severe regurg/obstruction
  • Persistent bacteremia ≥ 7 days
  • Abscess / fistula / heart block
  • Fungal IE
  • Large vegetation > 10 mm + recurrent emboli or severe regurgitation
  • MDR organism

298.2.1.6 POET Trial 2019

  • Stable NVE after 10d IV → switch to oral
  • Non-inferior outcomes
  • Practice-changing

298.2.1.7 Prophylaxis 2024

  • Only for highest-risk patients (prosthetic valve, prior IE, unrepaired cyanotic CHD, etc.)
  • Only dental with gingival manipulation
  • Amoxicillin 2 g 30-60 min pre

298.2.2 易混淆比范

Type Most Common Organism Course Treatment Notes
Subacute NVE Viridans Strep (oral) Indolent Pen G/ceftriaxone + gent
Acute NVE S. aureus Aggressive Vanc/oxacillin
IV drug user (R-sided) S. aureus (often MRSA) Acute Vancomycin
Prosthetic valve CoNS, S. aureus Indolent or acute Vanc + gent + rifampin
Culture-negative HACEK, Bartonella, Coxiella Variable Specific (doxy, etc.)
Strep gallolyticus GI source Subacute Colon cancer workup!
Fungal Candida Aggressive Echinocandin + surgery

298.2.3 Special Topics

298.2.3.1 IV Drug User R-Sided IE

  • Tricuspid common
  • Septic pulmonary emboli
  • Lower mortality than L-sided
  • 2-week regimen possible for uncomplicated MSSA TV IE

298.2.3.3 Pediatric IE

  • Often with CHD predisposition
  • S. aureus + viridans Strep common
  • Surgical indications similar