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PHA 550 > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

Endocarditis

A

inflammation of the endocardium (the membrane lining the chambers of the heart and covering the cusps of the heart valves )

can refer to infection of the heart valves

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2
Q

Endocarditis: signs and symptoms

A 
fever
chills
weakness
dyspnea
night sweats
weight loss
malaise
heart murmur (new or changing)
embolic phenomenon
splenomegaly
janeway lesions
osler nodes
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3
Q

Endocarditis: diagnosis

A

modified duke criteria (major and minor)

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4
Q

Endocarditis: major pathogens

A

streptococci
staphylococci
enterococci

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5
Q

Endocarditis: treatment approach

A

high dose parenteral bactericidal antibiotics for an extended period
(microorganisms enclosed within vegetations and fibrin deposits)

surgery (valvectomy, valve replacement)

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6
Q

Staphylococcal Endocarditis: IVDA (pathogen, valve effected, treatment)

A

S. aureus

tricuspid valve (R sided infective endocarditis)

2 week course of nafcillin or oxacillin PLUS aminoglycoside

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7
Q

Which organism is the MC cause of infective endocarditis among those with IVDA and venous catheters?

A

S. aureus

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8
Q

Which pathogen is a prominent cause of prosthetic valve endocarditis?

A

Staphylococcus epidermidis

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9
Q

Streptococcal Endocarditis

A

MCC: viridans streptococci

usually subacute

penicillin G (or ceftriaxone)

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10
Q

Streptococcal Endocarditis: viridans streptococci

A

common inhabitants of human mouth and gingiva (prophylaxis for dental work)

common cause of endocarditis in NATIVE valves

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11
Q

Enterococcal Endocarditis

A

MCC: E. faecalis

normal inhabitants of human GI tract and anterior urethra

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12
Q

HACEK organisms

A 
Haemophilus parainfluenzae
Haemophilus aphrophilus 
Actinobacillus actinomycetemcomitans 
Cardiobacterium hominis 
Eikenella corrodens 
Kingella kingae

gram negatives

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13
Q

Endocarditis: HACEK

A

native valve, community acquired

subacute

LARGE vegetations and emboli

high dose ampicillin with gentamicin for 4 weeks

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14
Q

What is the drug of choice for endocarditis?

A

beta lactam antibiotics

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15
Q

Endocarditis: Empiric Drug Therapy: Native Valve

A

vancomycin plus ceftriaxone

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16
Q

Endocarditis: Empiric Drug Therapy: Prosthetic Valve

A

vancomycin plus gentamicin plus rifampin

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17
Q

Native Valve Endocarditis: viridans group streptococci: PCN susceptible

A

4 weeks: PCN G or ceftriaxone or vancomycin

2 weeks: PCN G or ceftriaxone PLUS gentamicin

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18
Q

Native Valve Endocarditis: staphylococci

A

oxacillin sensitive and resistant drug therapy

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19
Q

Gentamicin

A

works synergistically with other agents to shorten the duration

beyond 2 weeks increases the risk for ototoxicity and nephrotoxicity

20
Q

Gentamicin: not intended for

A 
>65 years of age
children
CNVIII impairment
creatinine clearance <20mL/min
known cardiac or extracardiac abscess 
infection with Abiotrophia, Granulicatella, Gemalia
21
Q

Native Valve Endocarditis: viridans group streptococci: PCN resistant

A

PCN G (4 weeks) plus gentamicin (2 weeks)

ceftriaxone (4 weeks) plus gentamicin (2 weeks)

vancomycin (4 weeks)

22
Q

Native Valve Endocarditis: staphylococci: oxacillin susceptible

A

6 weeks:

  • nafcillin or oxacillin
  • cefazolin
  • vancomycin
  • daptomycin
23
Q

Native Valve Endocarditis: staphylococci: oxacillin resistant

A

6 weeks:

  • vancomycin
  • daptomycin
24
Q

Prosthetic Valve Endocarditis: viridans group streptococci: PCN susceptible

A

6 weeks
PCN G or ceftriaxone
2 weeks
with or without gentamicin

6 weeks
vancomycin

25
Q

Prosthetic Valve Endocarditis: viridans group streptococci: PCN resistant

A

6 weeks

  • PCN G plus gentamicin
  • ceftriaxone plus gentamicin
  • vancomycin
26
Q

Prosthetic Valve Endocarditis: staphylococci: oxacillin susceptible

A

> 6 weeks
nafcillin or oxacillin or vancomycin (may sub cefazolin if hypersensitivity)

> 6 weeks
plus rifampin

2 weeks
plus gentamicin

27
Q

Prosthetic Valve Endocarditis: staphylococci: oxacillin resistant

A

> 6 weeks
vancomycin plus rifampin

2 weeks
plus gentamicin

28
Q

Native and Prosthetic Valve Endocarditis: enterococci: susceptible

A

4-6 weeks

  • ampicillin plus gentamicin
  • PCN G plus gentamicin

6 weeks

  • ampicillin plus ceftriaxone
  • vancomycin plus gentamicin
29
Q

Native and Prosthetic Valve Endocarditis: enterococci: resistant

A

gentamicin resistant: use streptomycin

penicillin resistant:
6 weeks
-ampicillin sulbactam plus gentamicin
-vancomycin plus gentamicin

resistant to PCN, aminoglycodies, vancomycin:
>6 weeks
-linezolid
-daptomycin

30
Q

Endocarditis: HACEK

A

4 weeks

  • ceftriaxone
  • ampicillin or ampicillin-sulbactam
  • ciprofloxacin
31
Q

Endocarditis: culture negative native valve

A

vancomycin plus cefepime or ampicillin-sulbactam

32
Q

Endocarditis: culture negative prosthetic valve

A

EARLY (<1 year)
6 weeks
vancomycin plus cefepime plus rifampin plus gentamicin

LATE (>1 year)
6 weeks
vancomycin plus ceftriaxone

33
Q

Endocarditis: suspected Bartonella (culture negative)

A

6 weeks
ceftriaxone

2 weeks
plus gentamicin

6 weeks
with or without doxycycline

34
Q

Endocarditis: (culture positive) Bartonella

A

6 weeks doxycycline
plus
2 weeks gentamicin

35
Q

Daptomycin: ADE

A

myopathy

rhabdomyolysis

36
Q

Gentamicin: ADE

A

nephrotoxicity
ototoxicity
neuromuscular blockade

37
Q

Linezolid: ADE

A

thrombocytopenia
optic neuropathy
peripheral neuropathy

38
Q

Rifampin: ADE

A

hepatotoxicity

red/orange discoloration of bodily secretions

39
Q

Vancomycin: ADE

A

nephrotoxicity

red man syndrome

  • prolong infusion time from 1 to 2 hours
  • consider antihistamine prior to loading
40
Q

Endocarditis Prophylaxis: indications

A

highest risk cardiac conditions

  • prosthetic heart valve
  • prior diagnosis of infective endocarditis
  • cardiac transplantation with valvulopathy
  • congenital heart disease

NOT RECOMMENDED
for patients who undergo GI procedure

41
Q

Endocarditis Prophylaxis: procedures

A

any that require perforation of the oral mucosa or manipulation of the periapical region of the teeth or gingival tissue

tooth extraction
drainage of abscess
routine dental cleaning

42
Q

Endocarditis Prophylaxis: first line

A

oral amoxicillin

30-60 minutes before procedure

43
Q

Endocarditis Prophylaxis: unable to take oral meds

A

IM or IV ampicillin or cefazolin or ceftriaxone

44
Q

Endocarditis Prophylaxis: allergic to PCN (oral)

A

oral cephalexin or clindamycin or azithromycin

45
Q

Endocarditis Prophylaxis: allergic to PCN and unable to take oral meds

A

IV or IM clindamycin or cefazolin or ceftriaxone

IV vancomycin

PHA 550 (26 decks)

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