Bacteremia and Endocarditis

Question 1

gram positive bacteria, appears as lancet-shaped diplococci

Answer 1

strep pneumo

Question 2

T/F: Pneumonia always causes bacteremia

Answer 2

False. It happens but not always.

Question 3

Bacteremia during pneumonia is what type of bacteremia?

Answer 3

intermittent bacteremia

Question 4

2 types of intermittent bacteremia

Answer 4

1-after a procedure

2-in the setting of a bacterial infection, eg pneumonia, pyelonephritis, skin infection

Question 5

How many SETs (one aerobic bottle, one anaerobic) of bottles should be drawn from a patient, typically, to evaluate for bacteremia/sepsis?

Answer 5

three. try to draw from different sites, and from veins instead of indwelling lines/catheters.

Question 6

T/F - Staph epidermitis is a common cause of continuous bacteremia

Answer 6

False. It is a common contaminant. Very rarely acts as a pathogen.

Question 7

3 ways to reduce false positive cultures in blood draws.

Answer 7

• use more than one set
• proper aseptic technique
• avoid drawing blood thru catheters

Question 8

T/F: In cases of clinically significant bacteremia, blood cultures usually turn positive within 48 hours.

Answer 8

True

Question 9

3 situations in which additional sets of blood cultures should be ordered fr bacteremia.

Answer 9

• pt continues to have fevers despite therapy
• to document clearance of bacteremia with Staph aureus (even if no symptoms presently)
• when endocarditis is suspected

Question 10

definition of continuous bacteremia

Answer 10

bacteria present in the blood for long periods of time, reflecting an endovascular infection

Question 11

T/F - Endocarditis always involves the valves of the heart.

Answer 11

False. It can involve other surfaces of the heart. But most commonly the valves.

Question 12

Which two bacteria have surface proteins which make them more likely to attach to valves?

Answer 12

staphylococci and streptococci

Question 13

T/F: endocarditis from E.Coli is common

Answer 13

False. Bacteremia from E Coli is common, but it doesn’t attach to the valves well, hence it is very rare.

Question 14

What are the 3 most common organisms (or groups of org’s) that cause endocarditis

Answer 14

1- S. aureus
2- Viridans Strep
3 - Coagulase negative staph (especially mechanical valves)

Question 15

5 risk factors for endocarditis

Answer 15

• underlying structural heart disease
• IV drug use
• prosthetic valve
• catheter-related bacteremia
• prior episode of infective endocarditis

Question 16

Iv drug users often get which type of endocarditis?

Answer 16

-60-70% Staph aureus

Question 17

3 main complications of endocarditis

Answer 17

• local tissue destruction in heart (valve abscess)
• continuous bacteremia
• embolic lesions

Question 18

Clinical manifestations of endocarditis

Answer 18

Systemic: fever, myalgia, night sweat, wt loss.

Cutaneous:
rash, splinter hemorrhages

Ocular hemorrhages.

Question 19

What is the leading cause of death from endocarditis?

Answer 19

heart failure

Question 20

What is the leading surgical indication for endocarditis?

Answer 20

heart failure

Question 21

renal manifestations of endocarditis

Answer 21

microscopic hematuria
elevated creatinine

(caused by immune complex definition and infarcts)

Question 22

Importance of echocardiogram in endocarditis

Answer 22

It can help you find abnormalities in the valve. HOWEVER often negative in endocarditis! Don’t give up on the diagnosis if the echo is negative!

Question 23

3 key diagnostic findings for endocarditis

Answer 23

• highly elevated ESR and CRP
• EKG abnormalities
• positive blood cultures

Question 24

Culture negative endocarditis is most often due to ?

Answer 24

giving antibiotics before drawing blood.

previously was due to unculturable strains

Question 25

What is the Duke Criteria for infective endocarditis?

Answer 25

You must have one major criterion or 3 minor criterion for diagnosis.

Question 26

Major criteria for Duke Criteria endocarditis diagnosis.

Answer 26

• positive blood culture with organism typical of endocarditis
• positive echocardiographic signs
• serologic evidence of Coxiella (Q fever)

Question 27

Duke endocarditis criteria - minor criteria (6)

Answer 27

• predisposing heart condition
• IV drug Use
• fever >38C
• Vascular complications: emboli, aneurysm
• immunologic phenomena - Osler’s nodes, roth spots
• culture not meeting major criterie

Question 28

Treatment for endocarditis- type of antibiotics, administration

Answer 28

4+weeks of IV antibiotics!!!

-BactericCIDAL antibiotics needed!

No pills - concentrations don’t get high enough in the blood!

Question 29

Level of heart failure required for surgical indication

Answer 29

NYHA 3 or 4

Question 30

5 indications for surgical treatment for endocarditis.

Answer 30

• Heart failure
• fungal endocarditis
• perivalvular extension
• persistent bacteremia despite adequate antibiotic

Question 31

In which conditions should you give antibiotic prophylaxis before dental procedures (to prevent endocarditis)?

Answer 31

only 3 conditions (high risk, with conditions allowing for vegetation in the heart)

• prosthetic cardiac valve
• previous endocarditis
• congenital heart disease

Question 32

4 types of endoVASCULAR infections

Answer 32

-infection of vascular graft
-infection of central venous catheters
-suppurative thrombophlebitis
endarteritis

Question 33

3 main complications of endocarditis

Answer 33

• systemic dissemination
• immune complexes
• emboli