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Endocarditis Surgical Indication — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionEndocarditis Surgical IndicationSCE Infectious Diseases

A 65-year-old man with a metallic mitral valve on Warfarin develops Staphylococcus aureus native aortic valve endocarditis with aortic root abscess on TOE. Blood cultures have been positive for 10 days despite appropriate IV Flucloxacillin. What is the indication for surgery?

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Correct answer: E — Uncontrolled infection (paravalvular abscess and persistent bacteraemia despite appropriate antibiotics) — urgent surgical intervention

The ESC 2023 guidelines identify three main indications for surgery in active IE: (1) heart failure, (2) uncontrolled infection, (3) prevention of embolism. This patient has uncontrolled infection: paravalvular abscess formation plus persistent bacteraemia despite >7 days of appropriate antibiotics. This is an urgent surgical indication (within days). Delaying surgery in the presence of paravalvular abscess increases mortality. The aortic root abscess may also cause conduction defects (heart block) — serial ECGs are needed.

Reference: ESC 2023 – Endocarditis; BSAC 2012 – Endocarditis surgical indications