A patient with infective endocarditis caused by Staphylococcus aureus on a native mitral valve meets Duke criteria (2 major or 1 major + 3 minor). Which organism-specific finding is an indication for emergency surgery within 24 hours?

• A Persistent bacteraemia after 3 days of appropriate antibiotics
• B New onset bundle branch block on ECG
• C Septic emboli to the spleen
• D Vegetation > 10 mm with severe mitral regurgitation causing cardiogenic shock or pulmonary oedema ✓

Explanation

ESC 2023 endocarditis guidelines recommend emergency surgery (within 24 hours) for infective endocarditis complicated by severe valvular regurgitation causing haemodynamic compromise (cardiogenic shock or pulmonary oedema refractory to medical therapy). A vegetation >10 mm after embolic event or >10 mm with high embolic risk is an indication for urgent (within 48–72 hours) surgery. New BBB suggests periannular extension requiring urgent surgery. Persistent bacteraemia at 3 days also warrants urgent surgical consideration.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.