Bacteremia and Endocarditis

Question 1

Intermittent bacteremiaoccurs in all of the following EXCEPT:
A. After a dental procedure
B. Bacterial infection (pneumonia, pyelonophritis, soft tissue infection)
C. Infection of vascular graft
D. Endocarditis

Answer 1

C, D Occur in continuous bacteremia

Question 2

T/F:Blood cultures that turn positive within 1st 24 hours are likely to be clinically significant

Answer 2

False. Within the 1st 48 hours

Question 3

Additional sets of blood cultures should be ordered in the following situations EXCEPT:
A. If pt continues to have fevers despite adequate therapy
B. To document clearance of bacteria with Strep pneumoniae
C. When endocarditis is suspected

Answer 3

B.To document clearance of bacteria with Staph aueus

Question 4

Which of the following bacteria isleastlikely to adhere to valve surfaces in infective endocarditis?
A. Staphylococci
B. Streptococci
C. Gram negative rods

Answer 4

C

Question 5

Most common microbe that causes infective endocarditis

Answer 5

Staph aureus
#2: viridans strep
GU procedures: E. faecalis

Question 6

Most common microbe of IV drug use that causes infective endocarditis

Answer 6

Staph aureus

Question 7

All of the following are diagnositic findings of infective endocarditis EXCEPT:
A. Anemia
B. Multiple positive blood cultures
C. Decreases in ESR, CRP
D. Proteniuria

Answer 7

C. Marked elevated ESR, CRP >90%

A. Anemia 70-90%
B. Multiple positive blood cultures
D. Proteniuria 50-60%

Question 8

Modified Duke criteria used to diagnose ___

Criteria =

Answer 8

Infective endocarditis
1 major + 1 minor
OR 3 minors

Question 9

Major criteria of Modified Duke criteria (3)

Answer 9

Microbiologic:Continuous bacteremia w/ organism typical of IE
Echocardiographic: Oscillating vegetation in path of regurgitant jet, Perivalvular abscess, Partial dehiscence of prosthetic valve new regurgitant murmur
Serologic: Positive Coxiella (Q fever) phase II serology

Question 10

All of the following are minor criteriaof the Modified Duke criteria EXCEPT:
A. Predisposing heart condition
B. IV drug use
C. Fever >38 C
D. Vascular phenomena
E. Immunologic phenomena
F. Pulmonary phenomena
G. Culture results not meeting major criteria

Answer 10

F

Question 11

T/F: Bactericidal antibiotics are only necessary if patient is symptomatic and can be stopped once symptoms subside.

Answer 11

False. Bactericidal abx are needed. IV abx to maintain high levels.Give abx long enough to eradicate organisms in vegetation
Several weeks depending on organism and location of valve involved

Question 12

T/F: Valve diseae will likely remain evne when bacteria is eradicated

Answer 12

True

Question 13

T/F:IE prophylaxis abx based on increased lifetime risk of acquisition of IE is necessary.

Answer 13

False.Only use prophylaxis with dental procedures when pts have high turbulence diseasesExample:

• Prosthetic cardiac valve
• Previous IE
• Congenital heart disease