Bacterial Endocarditis post op

[The Thief]

Hey guys. I am 2 weeks out from my emergency AVR redo. Turns out I had bacterial endocarditis from some unknown bacterium. The cultures came back negative, but they took the cultures after they gave me an initial dose of antibiotics. They ended up replacing my mechanical valve with a new one, but also replaced my root and ascending aorta.

I'm on 6 weeks of vancomycin and rocephin via PICC line. My gums were bleeding for a bit before my emergency, so that's where I think it came from. I'm really focusing on immaculate oral hygiene now. Doctors couldn't identify the bacterium so they are very cautious. My cardioogist wants me to stay away from my cats, dogs and chickens. The chickens are easy but the mammals live indoors. I'm a teacher and she also wants me to stay home for 12 weeks to stay away from children. My infective disease doctor doesn't feel that staying home from work that long and staying away from animals is necessary.

For those of you who have had BE and/or an emergency AVR redo, how where your restrictions different from your first surgery? Where your exercise restrictions the same? Did you change anything due to infection risks? Any advice??
-Anthony

 

[ManiSham]

Hi

Sorry to hear that you had to go for a redo but glad that you are doing well now.

I had a severe case of endocarditis before my surgery and the vegetation were also removed during the OHS. I was given IV antibiotics for one month afterwards. I was warned regarding strict dental hygiene, not to scare you but endocarditis has a risk of recurring (I've been pretty ok for 9years now though). If your doctor advised you to keep away from your pets and job for a few days then you better do it. While I was in hospital pre OHS my endocarditis got worse and the doctors suspected it could be bacteria from the hospital (even from hos toilets).

Don't worry you will be fine once things settle down. will pray for you.

 

[ski girl]

Anthony I had pretty much exactly what happened to you, only I got a few more months (10 1/2) out of my initial AVR.

In my case they took the cultures before whacking me full of antibiotics (well, duh . . .) and I had a garden variety mouth bacteria. Unfortunately I self-diagnosed the flu when I first spiked a fever and didn't bother seeing my GP until four days later, so I'm pretty damn lucky to still be alive.

My cardiologist and surgeon were both MUCH more cautious than my infectious disease doctor, who was very cool (and said f*%k a lot). I had no restrictions in terms of being around animals, or children, or exercise, but he did give me an oral hygiene routine that we should probably ALL be given after our first op:
* Rinse with anti-bacterial mouthwash, ~1minute
* Wait a few minutes while it kills everything
* Brush
* Floss with TAPE floss, not the gum-chopping string stuff
This should be done 2-3x a day and you should never brush without pre-rinsing. Of course the usual still applies for pre-medicating before dentist appointments, but he said the most important thing is to rinse with anti-bacterial mouthwash before you go to the dentist, before they start poking around in your mouth, and after they finish.

The one thing they all agreed on was that next time I have a fever, don't sit on the couch suffering for four days before I do something about it! But after what I went through, my next fever will inspire a massive panic

 

[The Thief]

I was hoping you would reply Skigirl. Thanks for the advice. I didn't have the fever, only the shortness of breath due to the valve coming loose.

 

[OldManEmu]

Anthony BE was the cause of my first AVR. I did the PICC line thing before surgery as the surgeon wouldn't operate until I was cleared by the infectious diseases doctor unless I was in imminent danger of death. The risk of the new valve becoming infected is very high if you still have an active infection going on.
I am more inclined to follow the

infective disease doctor doesn't feel that staying home from work that long

. I went back to work for a couple of months after the BE was cleared up while I waited for surgery.
I haven't been advised not to go near pets, I don’t have any, however I am cautious around animals that a prone to scratching or biting.
The only precautions I have been told about is to premedicate before dental work, gastroscopies and colonoscopies.
I have no exercise restrictions other than avoiding very heavy lifting, defined as having to hold your breath and really strain.

 

[pellicle]

Anthony
As you probably know the cultures will be negative after the administration of antibiotics. Its vexing that they didn't culture earlier but that's how it goes.

The only thing I wish to add is that a bacteria which often goes undetected is the one I had. Propioni bacteria. As it happens it requires a much longer culture time to grow and as they are usually not looking for it (although why I don't know as it is a common infection with various prostheses) they don't find it - then classifying it as a mystery infection.

Will they also have you on long term oral antibiotics?

 

[Paleowoman]

While I was in hospital pre OHS my endocarditis got worse and the doctors suspected it could be bacteria from the hospital

When I saw one of my consultants a couple of days ago I mentioned that some fellow valve replacementers developed endocarditis within a few months of valve replacement. He told me that sometimes this happens due to the heart being exposed during the valve replacement operation as there's bugs in the air even in operating rooms

…wishing you a peedy recovery Anthony.

 

[Forrest]

Anthony,

I’m sorry to hear you got endocarditis after surgery and had to have a redo. However, I’m very glad to hear that you discovered the problem, got in promptly and they were able to repair things and get you started on the right course of antibiotics. What an ordeal you must of went through, and survived.

I had BE with my native valve shortly before replacing my congenital aortic valve. I’m no expert, but I hear that endocarditis that occurs once we have a prosthetic valve can be more risky to fix as there are more places for the infection to do damage or hide, but sounds like they were very successful with you. On a positive note, they are getting better at dealing with endocarditis. But as you already know, it’s still an extremely serious matter, one that can’t be treated lightly by us valve patients.

Once I got out of the hospital and completed a home course of Ceftriaxon via PICC line for another month, they had me come back after waiting 2 weeks to confirm through blood cultures that the infection was still gone. After treatment I asked when can I resume sports?, the doctor said I should start out slow since I might be a bit tired for a few weeks.

Fevers can be a big clue/symptom that you have BE, occurring most of the time, but I have heard of a few forum members who had BE that didn’t experience fevers, so it pays to know the various other symptoms. The American Heart Association and my treating inpatient cardiologist mentioned that once you have contracted BE you’re at an increased risk. I asked the inpatient cardiologist how much more risk? He said they don’t know exactly, but it’s somewhat higher than if I never got it before. My infectious disease doctor (I had a team of 3 docs treating me) said he felt that I’m not at much higher risk. I don’t worry about it too much anymore, I take prudent precautions where I have control (i.e., take premeds before dental visits, maintain healthy habits, clean any cuts I get, and know the symptoms), but other than that I think some of this has an element of randomness to it, so I don’t get too carried away. I know to act promptly if I am suspicious of symptoms, but so far at 4 and half years out I haven’t had to go in for anything. It’s not consuming me as I continue to live on. Best of luck to you in your recovery, sounds like you have the right team monitoring things.

 

[newmitral]

Hello Anthony,

I'm sorry to hear that you had to deal with endocarditis, but it sounds like it is under control.

I had endocarditis of my native valve, which is what necessitated my OHS and mitral valve replacement. I never had any fever from the endocarditis, and my primary initial symptom was a persistent cough.

As far as your doctor recommendations go, I was advised to avoid anyone who had colds, flu, etc. while I was home recovering with the 6 week PICC antibiotics following my valve replacement. Dogs, chickens and cats can probably expose you to new germs and bacteria, so my guess is that is the primary reason to avoid them until you are back up to full health.

Children carry all manner of viruses, bacteria, etc. so there again you are probably best to follow your doctor's advice and stay away from them as much as possible until the 12 week healing period is over. Your sternum won't be fully healed until about 12 weeks, so you don't want to catch anything that might cause coughing or sneezing, which might strain your sternum.

...how where your restrictions different from your first surgery?

Since I only had the one surgery for valve replacement due to the BE, I can't compare to any other prior surgeries.

I was told not to drive for 6 weeks post surgery to allow the sternum to heal. In the short-term I was told not to lift anything heavier than 5 pounds for the first 6 weeks.

I had no long-term restrictions on exercise, or anything else. I have not really changed anything significant as result of the BE. I have always had good oral hygiene, but I do now follow Ski-Girl's advice to use a mouthwash prior to brushing/flossing. I have also heard that those of us who get BE once are at slightly higher risk of getting it again, but even so the overall risk remains small.

I do now have to pre-medicate with amoxicillin prior to dental appointments, but that's really the only accommodation to BE that I have made.

 

[mcsf]

Before surgery I read Ski Girl's post in another thread about good dental hygiene. I have been fanatical about rinsing with mouthwash before brushing. I became "famous" in the ICU for my teeth brushing and mouthwash use. My biggest fear post surgery is endocarditis because of an oral bacteria.

 

[clay_from_nj]

That's why I believe in getting dirty and exposing yourself to as many bacteria as possible while you're young. http://www.nytimes.com/2009/01/27/health/27brod.html?_r=0

 

[Gail in Ca]

I had BE before my 3rd OHS. I was diagnosed wrongly at first, then, after a brain bleed from INR at around 9, they took it seriously and tested me for everything, but still thought I had arteritis in my brain!! I was offered to go to Stanford and there the cultures came back positive for staph lugdunensis, a very nasty form of staph that lives on the skin. I would be on vancomycin, gentimycin on PICC and rifampin orally for 6 weeks minimum. However, after my 1st 6 days in the hospital I was at home and felt warm, had another fever of 101, went to urgent care, they sent me back to Stanford, my cultures which they had kept growing were now changed from negative to positive. I was switched to nafcillin(PICC-23 hrs/day), rifampin still orally. This did the trick, but the damage was done to my mechanical valve, old graft, mitral valve.
While I was on the antibiotics, my docs said nothing about staying away from my dog/cat. In fact, my cat slept next to me, spooning me!
The visiting nurse just said to be careful with the PICC line, so that the animals don't accidentally pull it out while jumping up, that sort of thing.
At first I was super cautious about germs. But now, I am better, but still do all the things I think I should dental wise, and washing cuts, etc.
I don't remember any exercise restrictions, and my infectious disease doc said having BE only raises the risk of getting it again by 1-2%.

 

[Agian]

* Rinse with anti-bacterial mouthwash, ~1minute
* Wait a few minutes while it kills everything
* Brush
* Floss with TAPE floss, not the gum-chopping string stuff

What mouthwash do you use?

 

[mbeard]

I have become used to listerine.

 

[ski girl]

I use Listerine Zero, failing that, straight Listerine. At first I thought it was going to make my face explode it was THAT strong of a taste, but I didn't want any more BE so I kept at it and now it doesn't bother me at all.

 

[river-wear]

Hey Anthony, I hope you're feeling well and the second recovery isn't any tougher than the first. (Easier might be too much to expect, but I hope you can still make it to Levi's GranFondo this fall.)

Would you mind answering a question about your redo? Was there any particular reason the doc used a St. Jude the second time instead of putting in a new On-X?

 

[The Thief]

He said the St. Jude is a little easier to install. He said since the surgery was going to be tricky, the St. Jude would make it easier than the On-X.

 

[Jamey T]

Anthony I had pretty much exactly what happened to you, only I got a few more months (10 1/2) out of my initial AVR.

In my case they took the cultures before whacking me full of antibiotics (well, duh . . .) and I had a garden variety mouth bacteria. Unfortunately I self-diagnosed the flu when I first spiked a fever and didn't bother seeing my GP until four days later, so I'm pretty damn lucky to still be alive.

My cardiologist and surgeon were both MUCH more cautious than my infectious disease doctor, who was very cool (and said f*%k a lot). I had no restrictions in terms of being around animals, or children, or exercise, but he did give me an oral hygiene routine that we should probably ALL be given after our first op:
* Rinse with anti-bacterial mouthwash, ~1minute
* Wait a few minutes while it kills everything
* Brush
* Floss with TAPE floss, not the gum-chopping string stuff
This should be done 2-3x a day and you should never brush without pre-rinsing. Of course the usual still applies for pre-medicating before dentist appointments, but he said the most important thing is to rinse with anti-bacterial mouthwash before you go to the dentist, before they start poking around in your mouth, and after they finish.

The one thing they all agreed on was that next time I have a fever, don't sit on the couch suffering for four days before I do something about it! But after what I went through, my next fever will inspire a massive panic

I was never given that regimen, but I do that also. I have read enough about it to know that I never want to get it. When I was being discharged, the doctor kept saying things about oral health, and being consistent with my diet, including drinking.

 

[Roberta]

I use Listerine Zero, failing that, straight Listerine. At first I thought it was going to make my face explode it was THAT strong of a taste, but I didn't want any more BE so I kept at it and now it doesn't bother me at all.

We may want to consider taking it one step further: decontaminate your toothbrush.

http://europepmc.org/abstract/MED/17508674/reload=0;jsessionid=YON5WLVTHYyEod1wLLAq.18
Abstract Highlight Terms Highlight biological terms.
Diseases(1) Species(1) Chemicals(2)
The purpose of this study was to determine the extent of bacterial contamination of toothbrushes after use and the efficacy of chlorhexidine and Listerine in decontaminating toothbrushes. The effectiveness of covering a toothbrush head with a plastic cap in preventing contamination was also evaluated. It was found that 70% of the used toothbrushes were heavily contaminated with different pathogenic microorganisms. Use of a cap leads to growth of opportunistic microorganisms like Pseudomonas aeruginosa, which may cause infection in the oral cavity. Overnight immersion of a toothbrush in chlorhexidine gluconate (0.2%) was found to be highly effective in preventing such microbial contamination.

FYI. The morning of my surgery, I had to rinse with a chlorhexidine solution to reduce the 'bacterial load' before surgery. Wonder if this is standard procedure for all hospitals.

Anthony,
What an ordeal you have been through. I sincerely hope you are on your way to a continued and 'long lasting' recovery with no more bumps.

 

[coffeelover]

I have a question about BE: does anyone know if you can get BE from a strep throat infection?
If so, should those of us with mechanical valves go on antiobiotics if we have been around a sick family member,ill student who was diagnosed with strep throat? Is impetigo a bacterial infection that can cause BE?
Does anyone on this forum know which strains of bacteria are most likely to cause BE?