IE Flashcards
when does IE occur?
when bacteria or fungi enters the bloodstream and attaches to the inner lining of the heart (endocardium)
risk factors of IE
presence of prosthetic heart valve
intravenous drug users
structural heart disease
persistant bacteremia
poor dental hygiene
colon cancer or IBD (s.gallolyticus)
most common pathogens of IE
gram positive cocci»» gram negative
IVDU
higher risk for poly microbial IE
prosthetic valve IE
coagulase negative staphococci (CoNS)
IVDU microorganisms
s. aureus
CoNS
Group A & B streptococcus
fungi
early (<1 yr ) post prosthetic valve replacement
CoNs
S.aureus
aerobic neg bacilli
corynebacterium spp.
late (> 1yr) post prosthetic valve replacement
CoNS
s.aureus
viridans group streptococcus
enterococcus spp.
corynebacterium spp
poor dental health , post dental procedures
viridian’s group streptococci
nutritionally variant streptococci
HACEK organisms
Acute IE clinical presentation
rapid onset
high grade fever **
new cardiac murmur
myalgia
systemic emboli
subacute IE clinical presentation
gradual onset
low grade fever**
anemia
weight los
vascular manifestations
peripheral manifestations
Less virulent pathogens (VGS)
right sided IE
tricuspid and pulmonary valve
IVDUs
Septic Pulmonary emboli**
NO peripheral emboli and immunological vascular phenomena
Left sided IE
Mitral and aortic ( majority of IE cases)
Peripheral emboli or neurological features**
Staphylococcus aureus
most common cause of IE
IVDUs is typically involves triceps/ right sided IE
coagulase negative staphylococcus
typically causes PVE
most CoNS are methicillin resistant
staph lugdunenis= hyper virulent species
Native valve IE
s.aureus or CoNS
methicillin susceptible
cefazolin IV 2 gram q8h
or
Nafcillin/ oxacillin IV 2 g q4H
duration 6 weeks
only use Vanco for severe b lactam intolerance
Native valve IE
s.aureus or CoNS
methicillin resistant
Vancomycin IV
alternative= daptomycin IV
duration= 6 weeks