Prosthetic valve

- For surgical indications (heart failure, uncontrolled infection, prevention of embolic events) and timing see Circulation 2015; 132:1435-86, or European Heart J 2015; 36:3075-128, Table 22.

- Tailor antibiotic therapy to C&S results. β-lactams superior to vancomycin so preferred if susceptible. If penicillin allergy reported, allergy should be confirmed by an allergist and desensitization considered.

 
Usual Pathogens

S. aureus/MRSA
Coagulase negative Staph
Enterococcus spp
Viridans Group Strep including S. gallolyticus (S. bovis biotype I)
Enterobacterales
P. aeruginosa
Coryneform bacteria (e.g. Corynebacterium spp, Actinomyces spp, Propionibacterium spp)

 
Rare:

Legionella spp
Fungi
Mycobacterium spp

 

Empiric Therapy Dose Duration
Vancomycin 15mg/kg IV q8-12h 6 weeks
+    
Gentamicin 1mg/kg IV q8h 2 weeks
+    
Rifampin 300mg PO tid or 6 weeks
  600mg PO bid