Bacterial Pericarditis

Represent <1% of Pericarditis cases in Western Europe and U.S.
Represents <5% of cases worldwide (except for Tuberculous Pericarditis)
Non-Tuberculous Bacterial Causes are Uncommon
1. Most Pericarditis cases are instead viral induced and inflammatory (see Pericarditis Causes)

Seeding of Pericardium
1. Direct spread from thoracic infection (e.g. empyema)
2. Endocarditis with paravalvular abscess
3. Hematogenous spread (Trauma, procedures)
Organisms
1. Coxiella Burnetii (most common of the nontuberculous purulent causes)
2. Borelia Burgdorferi (most common of the nontuberculous purulent causes)
3. Staphylococcus aureus (high mortality)
  1. Empyema with direct spread or hematogenous spread in children
4. Streptococcus Pneumoniae
  1. More common prior to current Immunizations in U.S.
5. HaemophilusInfluenzae
  1. More common prior to current Immunizations in U.S.
6. Mycobacterium tuberculosis (mortality approaches 85% for untreated cases)
  1. See Tuberculous Pericarditis
  2. Most common cause in developing countries
7. Salmonella
8. Meningococcus
9. Syphilis
10. Whipple Disease
11. Rickettsia

See Pericarditis
Purulent Bacterial Pericarditis
1. Typically empiric antibiotics, then guided by Pericardiocentesis fluid culture and sensitivity
2. First-line antibiotics
  1. Vancomycin 15-20 mg/kg IV every 8-12 hours AND
  2. Ceftriaxone 2 g IV every 24 hours OR Cefepime 2 g IV every 12 hours
3. Alternative regimen
  1. Vancomycin 15-20 mg/kg IV every 8-12 hours AND
  2. Ciprofloxacin 750 mg orally twice daily OR 400 mg IV twice daily
Tuberculous Pericarditis
1. Most common cause of Pericarditis in developing world (esp. with HIV Infection)
2. See Tuberculous Pericarditis
3. See Active Tuberculosis Treatment
Interventions
1. During Pericardiocentesis, irrigation and Fibrinolytic agent instillation within Pericardium may be considered
2. Pericardial window may be needed in some cases