10 Infectious Heart disease Flashcards
What are the two “requirements” for infectioius endocarditis?
- “Something that sticks”
- staph and strep= 80% of cases
- “Something to stick to”
- abnormal heart valves or prosthetic device
What are some common bacteria in IE?
- staph aureus (even sometimes with normal valves)
- staph epidermidis (esp with prosthetic valves/devices)
- viridans group strep (VGS)
- enterococcus (esp in elderly or pts with GU disease)
- HACEK group (Gram negatives: Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella)
What pathogens should be suspected in an IV drug user IE?
- staph aureus
- pseudomonas
- candida albicans
What are some causes of culture negative endocarditis?
- coxiella burnetti
- bartonella
- brucella
What is the progression of IE?
- abnormal heart valves -> aberrant flow -> platelet-fibrin thrombus on injured endothelium
- risk for bacteremia -> bacteria enter blood stream (through skin or mucosal surface) -> adhere to thrombus
What are some common clinical presentations of IE?
- fever (chills, sweats)
- heart murmur (new/worse= especially concerning)
- anorexia, malaise
- noncardiac manifestation (e.g. emboli, splenomegaly, clubbing, petechiae, roth spot retinal hemorrhages)
- lab abnormalities
What are osler’s nodes? Janeway lesions?
- Oslers
- Painful Purple Pea sized bumps on Pulp of fingers
- Inflammatory/immune complexes
- Janeway
- Similar to Osler’s but painless
- Due to septic emboli
What are some common lab abnormalities of IE?
- anemia
- leukocytosis
- microscopic hematuria
- elevated ESR/CRP (inflammatory markers)
Why does it matter how long a patient has had a prosthetic valve/device?
Always consider staph aureus/epidermidis but…
- less than 1 year consider
- gram negatives (nosicomial infection)
- more than 1 year consider
- viridans group strep
What tests should be run if IE is suspected?
- at least 3 sets of blood cultures (from different sites)
- ECG (TEE>TTE)
What antibiotics should be given for MSSA infection of a native valve? What if there’s a penicillin allergy?
6 weeks of IV…
- Nafcillin and/or cefazolin
- allergy= vancomycin and/or daptomycin
What antibiotics should be given for MRSA infection of a native valve?
vancomycin and/or daptomycin
What antibiotics should be given for an MSSA infection of a prosthetic valve?
- IV nafcillin/oxacillin/cefazolin for 6 weeks
- IV/PO rifampin for 6 weeks (biofilms!)
- IV gentamicin for 2 weeks
**combo therapy when prosthetic valve involved
What antibiotics should be given for an MRSA infection of a prosthetic valve?
- IV vancomycin for 6 weeks
- IV/PO rifampin for 6 weeks (biofilms!)
- IV gentamicin for 2 weeks
**combo therapy when prosthetic valve involved
What antibiotics should be given for a VGS IE?
- penicillin/ceftriaxone 4-6 weeks (possibly add gentamicin as needed for 2 weeks)
- vancomycin 4-6 weeks
What antibiotics should be given for enterococci IE?
- penicillin/ampicillin 6 weeks
-
gentamicin or ceftriaxone 2-6 weeks
- or vancomycin with gentamicin 6 weeks
What antibiotics should be given for HACEK IE?
ceftriaxone or ciprofloxacin 4-6 weeks
When is endocarditis prophylaxis indicated?
For manipulation of gingiva/periapical teeth or perforation of oral mucosa in patients with…
- prosthetic valves
- previous IE
- cardiac transplant with valvulopathy
- congenital heart disease
What antibiotics are used for IE prophylaxis?
Oral: Amoxicillin and clindamycin
IV: Ampicillin and ceftriaxone
**single dose 30-60 min before procedure
What are some reasons for “culture negative” endocarditis?
- antibiotic treatment already started
- nutritionally variant strep (needs supplemental media)
- abiotrophia, granulicatella
- coxiella burnetti (Q fever; rural living/birthing of sheep)
- bartonella (“cat scratch” fever)
- brucella (unpasturized milk/cheese)
- tropheryma whipplei
What is the natural bacteria found in the anterior nares? (can cause IE)
Staph aureus
What is the natural bacteria found on the skin? (can cause IE)
Staph epidermidis (coag neg)
What is the natural bacteria found in the oral cavity? (can cause IE)
viridans strep (sanguis, mutans, mitis)
What is the natural bacteria found in the GI tract? (can cause IE)
enterococci (faecalis, faecium)
