2001 2002 Guidelines for the Prevention and Treatment of Infective Endocarditis (JCS 2003) h 1 1 2 3 4 5 6 7 8 9 2 1 2 3 1 2 3 4 1 2 5 1 2 1 G Streptococcus viridans Streptococcus bovis 2 G Streptococcus 3 Enterococcus 4 Staphylococcus 5 HACEK 6 Fungus 3 6 7 1 2 PVE 4 5 1 Circulation Journal Vol. 67, Suppl. IV, 2003 1083
2001 2002 1 2 2 1 2 3 4 5 6 7 8 9 10 11 DIC 1 1 2 3 2 1 2 1 1 2 1 2 3 4 5 6 3 1 2 3 4 1 2 1 2 3 4 3 1 2 4 1 2 vegetation 1 nonbacterial thrombogenic endocarditis NBTE NBTE NBTE 1 vegetation 1084 Circulation Journal Vol. 67, Suppl. IV, 2003
1 1 80 % 2 2 80 85 %Duke 1 38 1 2 1 3 5 1 IE A 2 Streptococcus viridans1streptococcus bovis HACEK Staphylococcus aureus Enterococcus B IE 12 2 3 4 1 2 A B A IE B 1 2 38.0 3 Janeway 4Osler Roth 5 IE 6IE 4 4 IE 1 Streptococcus viridans Circulation Journal Vol. 67, Suppl. IV, 2003 1085
2001 2002 3 80 85 % 4 Osler Janeway Roth 8 9 15 % 2 5 1 15 50 % 6 40 % 15 20 % Staphylococcus aureus 3 % 7 30 40 % Staphylococcus aureus 1.2 5 % 2 Streptococcus viridans Streptococus bovis HACEK Staphylococcus aureus Enterococcus faecalis Duke 2 24 3 10 ml 2 48 1086 Circulation Journal Vol. 67, Suppl. IV, 2003
3 1 1 23 2 98 % 60 % 3 10 mm 10 mm 20 % 40 % 10 mm 3 3 29 % 58 % 24 % 17 % 86 % 65 % 4 1 76 100 % 94 100 % 86 94 % 88 100 % 28 % 98 % 87 % 95 % 1 2 3 1 10 95 % 2 1 2 3 4 Circulation Journal Vol. 67, Suppl. IV, 2003 1087
2001 2002 5 1 IE IE IE No 1 Yes 2 1 2 3 TDM 4 MRSA MRSE methicillin-resistant Staphylococcus epidermidis Enterococcus 5PVE, prosthetic valve endocarditis 2 6 MIC minimum inhibitory concentration TDM therapeutic drug monitoring 8 2 1 2 2 1 Staphylococcus aureus G PCG 1 2400 1800 3000 6 G 8 12 g 1088 Circulation Journal Vol. 67, Suppl. IV, 2003
in vitro 4 G G 2 1 5 mm 2 34 1 Streptococcus bovis 3 2 Streptococcus viridans G 50 % 40 % G G G 4 2 4 3 3 60 G 4 6 2 6 PVE 4 6 1 2 3 VRE vancomycin-resistant enterococcus VRE 2 VRE in vitro 4 Streptococcus viridans Staphylococcus aureusstreptococcus pyogenes 1 - G nafcillin oxacillin 1 1 G G Circulation Journal Vol. 67, Suppl. IV, 2003 1089
2001 2002 3 1 G Streptococcus Streptococcus viridans Streptococcus bovis A G 2,400 1,800 3,000 6 4 B G C D E GA 60mg or 1mg/kg x 2 3/ 8 12g/ 4 6 60mg or 1mg/kg x 2 3/ 2 g x 1/ 60mg or 1mg/kg x 2 3/ 25mg/kg/loading dose20mg/kg/ 1 1 2 2 G Streptococcus F G A 60mg or 1mg/kg 2 3/ B G C H E 3 Enterococcus I C 8 12 g/4~6 60mg or 1mg/kg x 2 3/ 25mg/kg/loading dose20mg/kg/ 1 1 2 8 12 g/4 6 60mg or 1mg/kg x 2/ J 25mg/kg/loading dose20mg/kg/ 1 1 2 60mg or 1mg/kg x 2 3/ 4 Staphylococcus-methicillin sensitive K L 2 g x 3 4/ 60mg or 1mg/kg x 2 3/ 25mg/kg/loading dose20mg/kg/ 1 1 2 J 60mg or 1mg/kg x 2 3/ 5 Staphylococcus- -methicillin resistant M 25mg/kg/loading dose20mg/kg/ 1 1 2 e.g. 60mg or 1mg/kg x 2 3/ 2 2 4 2 4 2 G 2 PC 4 =25 40 g/ml =10 g/ml 4 2 4 4 2 4 4 6 4 6 4 6 4 6 4 6 1 4 6 1 4 6 1 1 3 6 2 4g/ - TDM - 1 2 4 g 3 4 1090 Circulation Journal Vol. 67, Suppl. IV, 2003
4 6 Streptococcus Streptococcus viridans Streptococcus bovis Enterococcus N G B O G GA 60mg or 1mg/kg x 2 3/ 8 12 g/ 6 4 60mg or 1mg/kg x 2 3/ P 25mg/kg/loading dose20mg/kg/ 1 1 2 J 60mg or 1mg/kg x 2 3/ 7 Staphylococcus-methicillin sensitive Q K 2 g x 3 4/ 60mg or 1mg/kg x2 3/ 450~600 mg/ 1 2 R 25mg/kg/loading dose20mg/kg/ 1 1 2 J 60mg or 1mg/kg x 2 3/ 450~600 mg/ 1 2 8 Staphylococcus- -methicillin resistant S 25mg/kg/loading dose20mg/kg/ 1 1 2 M e.g. 60mg or 1mg/kg x 2 3/ 450~600 mg/ 1 2 4 6 2 6 4 6 2 6 4 6 2 6 6 2 2 6 6 2 2 6 6 2 2 6 Enterococcus G 8 4 6 Enterococcus 8 4 6 Enterococcus 8 4 6 TDM 6 8 2 2 MRSA Staphylococcus epidermidis coagulase-negative staphylococci CNS MRSA TDM TDM 1 MRSA VRE 6 8 2 2 6 cytochrome P-450 Circulation Journal Vol. 67, Suppl. IV, 2003 1091
2001 2002 5 % 10 % HACEK 4 6 3 4 - in vitro Pseudomonas aeruginosa 3 4 In vitro 6 B B 5-FC - 3 6 7 % 30 % nutritionally variant streptococci SIRS systemic inflammatory response syndrome 5 1 60mg 1mg/kg 2 3 / 8 3 5 g/ml 1 g /ml 2 1 2g 1g 65 1 / 8 loading dose 25mg/kg 1 / 20mg/kg 1 /.1 red man loading dose 800 400mg/ 2 200 400mg 1 / 30 TDM 3 4 1 25 40 g/ml 10 g /ml 6 50 TDM 7 40 g/ml 20 g/ml * 450 600 mg/ 1 2 MRSA *TDM 1092 Circulation Journal Vol. 67, Suppl. IV, 2003
6 1 2 2 3 a Streptococcus viridans Enterococcus Staphylococcus aureus CNS Streptococcus viridans b Staphylococcus aureus c MRSA MRSE Staphylococcus aureus 4 5 empiric therapy targeted therapy 1 Streptococcus viridans 3 4 nutritionally variant streptococci HACEK 2 prosthetic valve endocarditis PVE 2 early PVElate PVE 40 % Staphylococcus epidermidis Staphylococcus aureus 2 50 % 10 % 7 1 2 2 1 2-3 4 MRSA - 1 1 Circulation Journal Vol. 67, Suppl. IV, 2003 1093
2001 2002 2 3 4 Regimen A~H Regimen N~P Regimen I, J Regimen K~M Regimen Q~S Regimen Regimen 7 Regimen Regimen 2 CNS MRSA 4 48 72 1 CRP 72 48 Staphylococcus aureus 1 2 Staphylococcus aureus 2 5 8 drug fever 3 4 Staphylococcus aureus 1094 Circulation Journal Vol. 67, Suppl. IV, 2003
8 1 2 drug fever 3 5 4 48 4 1 1 1 1 29 % 20 % 8 % Enterococcus Streptococcus pneumoniae Staphylococcus aureus 2 New York Heart Association NYHA 2 Staphylococcus aureus 3 NYHA 2 3 % Circulation Journal Vol. 67, Suppl. IV, 2003 1095
2001 2002 2 2 1 10 14 % 45 60 % 56 100 % 2 28 % 88 % 87 % 95 % 3 1 20 40 % 60 70 % 76 % 2 10 mm 2.80 12.9 % 65 % 10 15 mm 3 20 40 % 9.7 % 64.6 % 31.5 %2.8 %1.1 % Staphylococcus aureus 1096 Circulation Journal Vol. 67, Suppl. IV, 2003
10 % 23 % 4 CT MRI MRI 24 48 MR 5 mm 5 mm 7 10 CT CT 5 2 3 4 3 6 1.2 5.6 % 3 2-3 4 CT 2-3 TIA Circulation Journal Vol. 67, Suppl. IV, 2003 1097
2001 2002 CT 10 7 44 58.3 % CT MRI 90 95 % CT CT 8 9 11 % 9 27 % 10 CT 11 DIC in vitro in vivo DIC Staphylococcus aureus Pseudomonas aeruginosa DIC 3 5 % 30 % 1 1098 Circulation Journal Vol. 67, Suppl. IV, 2003
1 NYHA 2 CRP MRSA 3 7 10 Staphylococcus aureus 3 3 1 10 mm 10 mm 2 4 15 30 2 10 mm 2 24 45.5 % 4 2.3 % 4 66 4 % 81 189 20 % 9 31 44.4 % Circulation Journal Vol. 67, Suppl. IV, 2003 1099
2001 2002 3 5 % CT MRI MRA 2 1 viable graft 2 9 1 2 3 4 5 3 10 1 10 mm 2 10 mm 1 1 1 2 2 1 2 10 1100 Circulation Journal Vol. 67, Suppl. IV, 2003
1 6 8 10 1 2 1 2 3 ICD 1 1 19.4 6.7 74.6 10 6 1 2 3 Circulation Journal Vol. 67, Suppl. IV, 2003 1101
2001 2002 45 fi 2 11 1 11 PCI 2 3 1102 Circulation Journal Vol. 67, Suppl. IV, 2003
1 5 % 4 6 12 2 5 % 45 % 31 % 5 31 % 18 40.2 % 1000 2 5 % 12 2 Circulation Journal Vol. 67, Suppl. IV, 2003 1103
2001 2002 maximal barrier precautions 3 1 13 13 15 30 15 ml Streptococcus viridans Streptococcus viridans 2.0 g 50mg kg 2.0 g 30 mg kg 1.0 1.5 g 2.0 g 1104 Circulation Journal Vol. 67, Suppl. IV, 2003
14 2.0 g 1 1 50 mg kg 1 2.0 g 30 50 mg kg 30 600 mg 1 20 mg kg 1 2.0 g 1 50 mg kg 1 500 mg 1 15 mg kg 1 600 mg 30 20 mg kg 30 1.0 g 30 25 mg kg 30 1 15 2.0 g 30 600 mg 30 500 mg 45 300 mg 45 1 500 mg 45 1 400 mg 45 1 14 2 Enterococcus faecalis 16 17 3 Circulation Journal Vol. 67, Suppl. IV, 2003 1105
2001 2002 16 17 2.0 g 1.5 mg kg 120 mg 30 6 1 g 1 g 50 mg kg 2.0 g 1.5 mg kg 30 6 25 mg kg 25 mg kg 1.0 g 1 2 1.5 mg kg 120 mg 30 20 mg kg 1 2 1.5 mg kg 120 mg 30 1 2.0 g 1 1 50 mg kg 1 2.0 g 30 50 mg kg 30 1.0 g 1 2 30 20 mg kg 1 2 30 4 IVH 18 1 2 3 4 5 1106 Circulation Journal Vol. 67, Suppl. IV, 2003
18 1 2 Duke 1 25 % Osler Roth Janeway 2 2 3 20 % 3 80 % Circulation Journal Vol. 67, Suppl. IV, 2003 1107
2001 2002 4 20 Streptococcus viridans Streptococcus bovis 19 19 % % 56 100 10 50 8 83 14 50 40 79 9 44 16 38 2 42 12 21 Osler 7 8 9 36 Roth 0 6 5 20 Janeway 0 10 9 47 0 10 36 67 G 1 1 * G 4-6 2 4 2 4-6 Staphylococcus aureus 6-8 2 * 6-8 Staphylococcus aureus 6-8 2 Staphylococcus epidermidis 6-8 4-6 4-6 2 3 Haemophilus sp 4-6 1 20 2 4-6 2 6-8 2 6-8 2 G G 6-8 Fungus B B 8 * G 20 30 kg 4 6 3 7.5 mg kg 3 30 40 mg kg 2 4 100 mg kg 4 :75 100 mg kg 2 200 300 mg kg 4 B 0.5 1.0 mg kg 1 TDM 1108 Circulation Journal Vol. 67, Suppl. IV, 2003
Ross Fontan 4 10 20 1 2 AZM Azithromycin AMPH-B Amphotericin-B AMPC Amoxicillin ABK Arbekacin ABPC Ampicillin IPM/CS Imipenem/cilastatin CAM Clarithromycin CLDM Clindamycin GM Gentamicin SBT/ABPC Sulbactam/ampicillin SBT/CPZ Sulbactam/cefoperazone CEZ Cefazolin CDX Cefadroxil CEX Cefalexin CDTR Cefditoren CTRX Ceftriaxone TEIC Teicoplanin VCM Vancomycin G PCG Penicillin G RFP Rifampicin Circulation Journal Vol. 67, Suppl. IV, 2003 1109