Synopsis
Recognise native-valve infective endocarditis, preserve blood-culture yield, sequence echocardiography and coordinate prolonged directed therapy with timely surgery and embolic assessment.
- Suspect infective endocarditis with persistent fever plus a murmur, embolic event, vascular or immune phenomenon, risk valve or unexplained bacteraemia.
- In a stable adult, obtain three correctly filled peripheral blood-culture sets from separate venepunctures before any antibiotic.
- Do not wait for the full sampling sequence in septic shock; collect cultures rapidly and start intravenous treatment.
Key red flags
New severe regurgitation with pulmonary oedema or cardiogenic shock requires emergency valve-surgery assessment.
A new regurgitant murmur, heart-failure signs or pulmonary oedema supports valve destruction, although absence of a murmur does not exclude disease.
Investigation priorities
Recover the organism and susceptibility before antimicrobial exposure in a stable patient.
Management branches
Endocarditis is suspected and the patient is haemodynamically stable without immediate organ-threatening sepsis.
- Take three peripheral blood-culture sets from separate venepunctures before any antibiotic and document every recent antimicrobial dose.
- Perform TTE promptly, ECG, renal and liver assessment, urinalysis and focused examination for heart failure, emboli, portals and metastatic infection.
Key medicines
Empirical native-valve endocarditis regimenGive the exact local intravenous endocarditis combination after three culture sets when stable, adjusted for acuity, allergy, renal function, valve history and healthcare exposure.
Flucloxacillin for MSSA native-valve diseaseGive 2 g intravenously every four hours for methicillin-susceptible Staphylococcus aureus native-valve endocarditis, with specialist-defined duration usually measured in weeks.