Great episode. High index of suspicion definitely key…had a GUCH patient a while back who returned from Thailand with a fever and kind of dengue-ish rash and some lung infiltrates, admitted for work up under ID, who diagnosed a RLL pneumonia. Turned out to have subacute IE. From the way it’s told it sounds like the nurse in the strep viridans case had 3 sets of cultures taken – somebody presumably thinking IE?

Just want to clarify for everyone that when you are referring to coagulase-negative Staphylococcus that is not the same as Staphylococcus aureus. There are more than 20 species of coagulase-negative Staphylococcus (e.g., Staphylococcus epidermis). Staphylococcus is the genus name and the second name is the species.
Luis

How timely. Here is an endocarditis lawsuit that was just settled in the Bangor area. The case turned on whether or not the PCP was informed of the positive blood cultures and there was a comparative negligence reduction in the award due to the patient being informed of the result and electing not to act on it. The assertion by the hospital that when the blood cultures returned was that a 13 minute conversation with the patient telling him exactly what was going and how critically important coming back to the hospital was. Think long and hard about what you… Read more »

This talk was a mind changer for me.last night I had a 50 year old female with a mechanical valve and A.Fib and NEW CHF,hemoptysis and fever.everyone thought of just pneumonia.but she is admitted to CCU as invective endocarditis.
Dr Hamza,ED Doc
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Great to hear all of your comments The RN I mentioned on the podcast was cultured x 2. The diagnosis of IE was a fluke of sorts. Was not on anyone’s radar. The key is to a gram positive culture result seriously especially if it is a pathognomonic IE bug

Scott and David, Thanks for the show on IE. I am looking at adjusting our blood culture basic orders in the ED and want to make a case for pulling the cultures at 15 or 30 min intervals but don’t see studies that emphasize the timing except in relation to fever. The opinion of Up To Date is that spacing of the samples does not change yield nor does timing around fever. They site Weinstein from a 96 article in Clinics of Infectious Disease http://www.uptodate.com/contents/blood-cultures-for-the-detection-of-bacteremia/abstract/4?utdPopup=true. Any suggestions? Thanks Paul.

What are your thoughts on adding gentamicin to an empiric IE regimen, plus or minus a penicillin/beta-lactamase inhibitor for the sickest IE patients?

Thanks,
Sarah
EM Resident