skip to main content

Healthcare-associated Native Valve IE — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateValvular Heart DiseaseHealthcare-associated Native Valve IEEECC

A 70-year-old man 5 days after CABG develops fever (38.8°C), new murmur, and blood cultures positive for Staphylococcus epidermidis (coagulase-negative Staphylococcus). TOE shows a vegetation on the native aortic valve. Is this early prosthetic valve endocarditis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — No — the vegetation is on the NATIVE aortic valve; this is native valve endocarditis occurring in the post-operative setting; however, healthcare-associated IE (nosocomial onset) should be considered, which carries a worse prognosis than community-acquired NVE and requires treatment with anti-staphylococcal antibiotics

Healthcare-associated (nosocomial) infective endocarditis accounts for 20-30% of all IE and has distinct features: (1) acquisition during hospitalisation or from invasive procedures; (2) organisms: S. aureus and coagulase-negative staphylococci (S. epidermidis) are the most common; (3) higher mortality than community-acquired IE. Importantly, this patient has vegetation on a NATIVE valve (the aortic valve was not replaced — he had CABG only), so this is native valve endocarditis, not PVE. If a valve HAD been replaced, post-surgical PVE is classified as: early (<12 months post-surgery — nosocomial organisms, worse prognosis) vs late (>12 months — community organisms, similar to NVE). The 2023 ESC IE Guidelines recommend prolonged IV antibiotics (4-6 weeks) and early surgical consultation for all healthcare-associated IE.

Reference: ESC (2023): IE Guidelines