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HACEK Endocarditis — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionHACEK EndocarditisSCE Infectious Diseases

A 60-year-old man develops a prosthetic valve endocarditis caused by a HACEK organism (Aggregatibacter actinomycetemcomitans). The organism is beta-lactamase negative. What is the recommended treatment?

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Correct answer: EIV Ceftriaxone 2 g daily for 6 weeks (prosthetic valve — 6 weeks minimum)

HACEK organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) are fastidious Gram-negative bacteria that cause ~5% of endocarditis cases. They are slow-growing and may initially present as culture-negative endocarditis (require prolonged incubation). IV Ceftriaxone 2 g daily is the treatment of choice. Duration is 4 weeks for native valve and 6 weeks for prosthetic valve endocarditis. Ampicillin is an alternative if the organism is beta-lactamase negative. HACEK organisms are intrinsically resistant to Vancomycin.

Reference: ESC 2023 – Endocarditis guidelines; BSAC 2012 – Endocarditis