II. Epidemiology

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

III. Causes

  1. Seeding of Pericardium
    1. Direct spread from thoracic infection (e.g. empyema)
    2. Endocarditis with paravalvular abscess
    3. Hematogenous spread (Trauma, procedures)
  2. 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

IV. Findings

  1. See Pericarditis
  2. Ill or septic appearing, febrile patients

V. Differential Diagnosis

VI. Diagnosis

  1. Pericardiocentesis for Gram Stain and culture

VII. Management

  1. See Pericarditis
  2. 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
  3. Tuberculous Pericarditis
    1. Most common cause of Pericarditis in developing world (esp. with HIV Infection)
    2. See Tuberculous Pericarditis
    3. See Active Tuberculosis Treatment
  4. Interventions
    1. During Pericardiocentesis, irrigation and Fibrinolytic agent instillation within Pericardium may be considered
    2. Pericardial window may be needed in some cases

VIII. Prognosis

  1. Associated with worse prognosis than typical idiopathic or Viral Pericarditis

IX. References

  1. (2016) Sanford Guide, accessed 4/8/2016
  2. Klasek and Alblaihed (2023) Crit Dec Emerg Med 37(6): 4-11
  3. Pankuweit (2005) Am J Cardiovasc Drugs 5(2): 103-12 [PubMed]

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Related Studies

Ontology: Acute purulent pericarditis (C0265149)

Concepts Disease or Syndrome (T047)
ICD10 I30.1
SnomedCT 266236008, 194919000, 2554006
English Acute purulent pericard.unsp., Acute purulent pericarditis unspecified, PERICARDITIS ACUTE SUPPURATIVE, purulent pericarditis, purulent pericarditis (diagnosis), Suppurative pericarditis, Pericardial empyema, Purulent pericarditis, Acute purulent pericarditis unspecified (disorder), pericarditis acute purulent, Acute purulent pericarditis (diagnosis), Acute purulent pericarditis, Acute suppurative pericarditis, Acute purulent pericarditis (disorder), pericarditis; purulent, pericarditis; suppurative, purulent; pericarditis, suppurative; pericarditis, Pericarditis, purulent, Acute pericarditis, purulent, Acute pericarditis, suppurative, Pericarditis, suppurative
Italian Pericardite purulenta, Empiema pericardico
Dutch pericardiaal empyeem, pericarditis; etterig, pericarditis; purulent, pericarditis; suppuratief, purulent; pericarditis, suppuratief; pericarditis, etterende pericarditis
French Empyème péricardique, Péricardite purulente
German Perikardempyem, Eitrige Perikarditis
Portuguese Empiema pericárdico, Pericardite purulenta
Spanish Empiema pericárdico, pericarditis purulenta aguda no especificada, pericarditis purulenta aguda no especificada (trastorno), pericarditis purulenta aguda, pericarditis supurativa aguda (trastorno), pericarditis supurativa aguda, Pericarditis purulenta
Japanese 化膿性心膜炎, 心嚢蓄膿, シンノウチクノウ, カノウセイシンマクエン
Czech Empyém perikardu, Hnisavá perikarditida
Hungarian Pericardialis empyema, purulens pericarditis

Ontology: Bacterial pericarditis (C0340445)

Concepts Disease or Syndrome (T047)
SnomedCT 233883000
Italian Pericardite batterica
Japanese 細菌性心膜炎, サイキンセイシンマクエン
English bacterial pericarditis (diagnosis), bacterial pericarditis, Bacterial pericarditis, Bacterial pericarditis (disorder), bacterial; pericarditis, pericarditis; bacterial
Czech Bakteriální perikarditida
Hungarian bacterialis pericarditis
Dutch bacterieel; pericarditis, pericarditis; bacterieel, bacteriële pericarditis
Spanish pericarditis bacteriana (trastorno), pericarditis bacteriana, Pericarditis bacteriana
Portuguese Pericardite bacteriana
French Péricardite bactérienne
German bakterielle Perikarditis