Synopsis
Recognise infection involving prosthetic valves or cardiac electronic devices, preserve microbiological evidence, define hardware involvement and coordinate complete source control with prolonged directed antimicrobial therapy.
- Establish exactly what was implanted, when, why and whether any revision, haematoma, wound problem or recent bloodstream infection occurred.
- In a stable adult obtain three peripheral blood-culture sets before antibiotics; in shock collect rapidly without delaying resuscitation.
- Start with TTE but use TOE early because prosthetic shadowing and lead position reduce transthoracic sensitivity.
Key red flags
New prosthetic-valve regurgitation, rocking or dehiscence with heart failure requires emergency cardiac-surgical assessment.
Fever, malaise, new regurgitant murmur, heart failure or embolus in anyone with a replacement valve should trigger endocarditis assessment.
Investigation priorities
Identify bloodstream organisms before antimicrobial exposure and distinguish sustained infection from contamination.
Management branches
There is shock, pulmonary oedema, severe prosthetic dysfunction, dehiscence or conduction deterioration.
- Use ABCDE, obtain several blood-culture sets rapidly, measure lactate and support oxygenation and circulation without excessive fluid in valve failure.
- Start the locally approved empirical prosthetic-endocarditis regimen after cultures, adjusted for implant timing, allergy, renal function and healthcare resistance.
Key medicines
Empirical prosthetic-valve regimenUse the exact local intravenous endocarditis combination immediately after cultures in instability, selected for early versus late implant, healthcare exposure, allergy, body weight and renal function.
Flucloxacillin for susceptible staphylococciGive 2 g intravenously every four hours when methicillin-susceptible Staphylococcus aureus is confirmed, with duration and any combination component set by the endocarditis team.