Infective endocarditis Flashcards
(48 cards)
What bacteria are associated with prosthetic valves within one year of replacement & intravenous drug use?
Staphylococci
What bacteria can be described as “Community-acquired disease and underlying cardiac abnormalities (e.g., mitral valve prolapse or rheumatic heart disease)”
Streptococci
How many blood cultures should be collected?
Continuous bacteremia; three sets of blood cultures should be collected over 24 hours
Cutaneous manifestations:
1) What are Osler nodes?
2) What are Janeway lesions?
3) What are Splinter hemorrhages?
4) Are petechiae painful?
1) Painful and tender [bumps on feet and hands]
2) Painless [lesions]
3) Thin, linear hemorrhages under nail beds of fingers and toes
-Proximal lesions more commonly associated with endocarditis
4) Painless
There’s a diminished density for _______-sided vegetations
right
Colonization may cause heart failure in ___________% of cases of IE
50–60%
1) What may right sided endocarditis lead to?
2) What abt left-sided?
1) Pulmonary abscesses
2) Spleen or cerebral infarction
What criteria is used to diagnose endocarditis? Describe this criteria
Modified Duke Criteria:
1) Pathological criteria: histological examination
2) Clinical criteria: 2 major criteria; 1 major and 3 minor criteria; 5 minor criteria
What are the major criteria for infective endocarditis based on? (2 things)
1) Blood cultures
2) Evidence of endocardial involvement
Describe the blood culture-based major criteria for infective endocarditis
1) Viridans streptococci, Streptococcus bovis, HACEK group, Staphylococcus aureus; or
2) Community-acquired enterococci, in the absence of a primary focus; or
3) Microorganisms consistent with infective endocarditis from persistently positive blood cultures, defined as follows:
A) At least two positive cultures of blood samples drawn greater than 12 hours apart; or
B) All of three or a majority of four or more separate cultures of blood (with first and last sample drawn at least 1 hour apart
What would provide evidence of endocardial involvement?
Echocardiogram positive for infective endocarditis
List the minor criteria of infective endocarditis
1) Predisposing heart condition, or injection drug use
2) Temp > 100.4°F
3) Vascular phenomena
4) Immunologic phenomena
5) Microbiologic evidence
List the 2 kinds of Echocardiographs & which is usually performed first
1) TTE: Transthoracic echocardiograph
-Usually performed first
2) TEE: Transesophageal echocardiography
You should obtain TEE or TTE within ______ hours of initial evaluation and after the ________________________ to establish new baseline valve and ventricular function
12; completion of therapy
Should you begin empiric therapy if blood cultures are taking forever?
May be held if not acutely ill until blood or tissue cultures or serologic tests are available
Directed therapy:
___________ doses of parenteral antimicrobials, as opposed to oral antimicrobials, are currently recommended to achieve bactericidal concentrations within vegetations
Large
Directed therapy:
An ___________ duration of therapy is required, even for susceptible pathogens, because microorganisms are enclosed within valvular vegetations and fibrin deposits
extended
True or false: Home therapy is a potential option for IE
True
(but many clinicians are uncomfortable with outpatient IV therapy because central venous access is required)
Heart failure, persistent bacteremia, persistent vegetation, an increase in vegetation size, or recurrent emboli despite prolonged antimicrobial treatment, valve dysfunction, paravalvular extension (e.g., abscess), or endocarditis caused by difficult to treat or resistant organisms (e.g., fungi or gram negative bacteria) when accompanied by IE are all indications for what?
Surgery
In most surgical cases, _________ and _________ replacement are performed to remove infected tissue and to restore hemodynamic function
valvectomy and valve
Surgery is performed in about ______% of all cases of IE
50%
Streptococcal endocarditis: Streptococcus pneumoniae, Streptococcus pyogenes, and group B, C, and G streptococci are ____[common/ uncommon]_________
uncommon
What bacteria inhabit the human mouth and gingiva and may cause transient bacteremia during dental procedures?
Viridans group streptococci
What bacteria is associated with GI pathology?
Streptococcus gallolyticus
