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ID > IE > Flashcards

IE Flashcards

1
Q

when does IE occur?

A

when bacteria or fungi enters the bloodstream and attaches to the inner lining of the heart (endocardium)

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2
Q

risk factors of IE

A

presence of prosthetic heart valve

intravenous drug users

structural heart disease

persistant bacteremia

poor dental hygiene

colon cancer or IBD (s.gallolyticus)

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3
Q

most common pathogens of IE

A

gram positive cocci»» gram negative

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4
Q

IVDU

A

higher risk for poly microbial IE

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5
Q

prosthetic valve IE

A

coagulase negative staphococci (CoNS)

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6
Q

IVDU microorganisms

A

s. aureus
CoNS
Group A & B streptococcus
fungi

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7
Q

early (<1 yr ) post prosthetic valve replacement

A

CoNs
S.aureus
aerobic neg bacilli
corynebacterium spp.

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8
Q

late (> 1yr) post prosthetic valve replacement

A

CoNS
s.aureus
viridans group streptococcus
enterococcus spp.
corynebacterium spp

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9
Q

poor dental health , post dental procedures

A

viridian’s group streptococci
nutritionally variant streptococci
HACEK organisms

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10
Q

Acute IE clinical presentation

A

rapid onset
high grade fever **
new cardiac murmur
myalgia
systemic emboli

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11
Q

subacute IE clinical presentation

A

gradual onset
low grade fever**
anemia
weight los
vascular manifestations
peripheral manifestations

Less virulent pathogens (VGS)

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12
Q

right sided IE

A

tricuspid and pulmonary valve
IVDUs
Septic Pulmonary emboli**

NO peripheral emboli and immunological vascular phenomena

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13
Q

Left sided IE

A

Mitral and aortic ( majority of IE cases)
Peripheral emboli or neurological features**

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14
Q

Staphylococcus aureus

A

most common cause of IE
IVDUs is typically involves triceps/ right sided IE

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15
Q

coagulase negative staphylococcus

A

typically causes PVE
most CoNS are methicillin resistant
staph lugdunenis= hyper virulent species

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16
Q

Native valve IE
s.aureus or CoNS
methicillin susceptible

A

cefazolin IV 2 gram q8h
or
Nafcillin/ oxacillin IV 2 g q4H

duration 6 weeks

only use Vanco for severe b lactam intolerance

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17
Q

Native valve IE
s.aureus or CoNS
methicillin resistant

A

Vancomycin IV

alternative= daptomycin IV

duration= 6 weeks

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18
Q

prosthetic valve IE
s.aureus or CoNS
methicillin susceptible

A

Nafcillin/oxacillin IV 2 gram q4h
plus
rifampin PO/IV 300 mg q8h (900 mg/day)
plus
gentamicin IV 1mg/kg q8h

alternative; cefazolin IV gram q8h

duration: 6 weeks , gentamicin: only first two weeks

19
Q

Prosthetic valve IE
s.aureus or CoNS
methicillin resistant

A

vancomycin IV
plus
rifampin PO/IV 300 mg q8h (900 mg/day)
plus
gentamicin IV 1mg/kg q8h

alternative: daptomycin IV

duration: 6 weeks , gentamicin: only first two weeks

20
Q

Native valve IE
virdiadans Group strep or strep. gallolyticus
highly penicillin susceptible

A

aqueous PCN G IV 18 mill units/day
or
ceftriaxone IV 2 g q24
plus/ or minus
gentamicin IV 3mg/kg q24hr

preferred regimen= without gentamicin synergy

duration: 4 weeks

21
Q

Native valve IE
virdiadans Group strep or strep. gallolyticus
PCN relatively or fully resistant

A

cerftriaxone IV 2 g q24h
plus/minus
gentamicin IV 3 mg/kg q24h

or
vancomycin

altenative:PCN G plus gentamicin

duration: 4 weeks

22
Q

prosthetic valve IE
virdiadans Group strep or strep. gallolyticus
highly penicillin susceptible

A

aqueous PCN G IV 18 mill units/day
or
ceftriaxone IV 2 g q24
plus/ or minus
gentamicin IV 3mg/kg q24hr

gentamicin does NOT improve cure rates vs. blactams

duration 6 weeks

23
Q

prosthetic valve IE
virdiadans Group strep or strep. gallolyticus
PCN relatively or fully resistant

A

cerftriaxone IV 2 g q24h
plus
gentamicin IV 3 mg/kg q24h

or
vancomycin

altenative:PCN G plus gentamicin

PCN G 24 mill units /day plus gentamicin synergy alternative

24
Q

native and prosthetic valve
enterococci (ampicillin suseptible)

A

double beta lactam regimen
- ampicillin IV 2 gram q2h
plus
-ceftriaxone IV 2 g q12h

duration: 6 weeks (for both

25
Q

native and prosthetic valve
enterococci (ampicillin resistant or beta lactam intolerance/allergy)

A

vancomycin IV
plus
gentamicin IV 1mg/kg q8h

Gentamycin for ENTIRE treatment course

duration: 6 weeks (NVE), >= 6 weeks (PVE)

26
Q

native and prosthetic valve
enterococci (ampicillin and vancomycin resistant)

A

daptomycn 10-12 mg/kg q24hr
drug of choice

27
Q

drug of choice for streptococci

A

pen G

28
Q

drug of choice for MSSA

A

Nafcillin/oxacillin or cefazolin

29
Q

drug of choice for MRSA

A

vancomycin

30
Q

stepwise approach for streptococcus

A
  1. penicillin look at MIC
  2. ceftriaxone
  3. vancomycin
31
Q

stepwise approach for staphylococcus

A
  1. oxacillin/ceftazolin
  2. vancomycin
  3. daptomycin
32
Q

when to use gentamicin synergy

A

s.aureus PVE
enterococci
PCN resistant strep (nv/PVE)

33
Q

general rule for duration of therapy

A

loneger for PVE

34
Q

Native and prosthetic valve
HACEK organisms (gram neg)

A

certtriaxone (preferred)
ampicillin/sulbactam
ciprofloxacin PO 500 mg q12 h (intolerance to beta lac)

4weeks NV
6weeks PVE

35
Q

indication for IE prophylaxis indication

A
  • dental procedures
    -pts at risk for iE development and high risk of for poor IE outcomes
36
Q

when is duration of therapy counted for?

A

first day of a negative blood culture

obtain at least two blood cx every 24-48 hrs under cleared

37
Q

if operative heart valve is are positive, when do you start counting # of treatment days

A

start counting # of treatment days from valve surgery

38
Q

if operative heart valve is are negative, when do you count treatment days

A

count # of treatment days administered before surgery into overall duration

39
Q

Major Criteria

A

evidence of endocardial involvement
ECHO positive for IE**
Single blood cx for coxiella burnetii**
2 or more separate blood culture or
3 or a majority of >4= separate blood cx for typical microorganism consistent w IE:
- viridian’s Group strep
-s.gallolyticus
-HACEK organism
-s. aureus**
-community acquired enterococci

40
Q

Minor criteria

A

predisposition, predisposing heart disease, or IVDU
fever
Vascular phenomena
Immunological phenomena
positive blood cx that does not met major criterion

41
Q

what type of antibiotics is needed to sterilize vegetation with high bacterial densities

A

bactericidal antibiotics

42
Q

why is prolonged therapy needed for IE

A

to ensure complete eradication

required since vegetations have high bacterial densities + slower antibiotic bactericidal activity

43
Q

solution for antimicrobial considerations

A

prolonged, parenteral**, high dose, bactericidal antibiotic therapy

ID (27 decks)

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