Bacteremia + Endocarditis Flashcards
How often do we repeat blood cultures in SAB (until negative)?
every 48-72 hours
When do we use echocardiography and what types are used?
used in ALL patients with SAB
1. TTE (transthoracic) performed first
2. TEE (transesophageal) performed after TTE
How are catheters managed in SAB?
short-term catheter - remove ASAP
long-term catheter - remove unless major contraindication
When do we replace catheters in SAB?
after blood cultures are negative for 48-72 hours
MRSA bacteremia treatment
Vancomycin 15-20mg/kg IV q8-12h
Daptomycin 6mg/kg IV q24h
MSSA bacteremia treatment
nafcillin 2 grams IV q4h
What NOT to use for MSSA bacteremia
- vancomycin
- combo with rifampin
- combo with aminoglycosides
Duration of treatment: uncomplicated SAB
14 days of IV therapy from first negative blood culture
Duration of treatment: complicated SAB
4 weeks
Duration of treatment: complicated SAB with metastatic infection
6-8 weeks
Mortality rate of SAB
20-40%
Higher mortality in SAB is associated with what?
- increasing age
- female
- immunosuppression
- presence of comorbidities
- MRSA
- Bacteruria
- sepsis/shock
- Time to positivity of blood cultures < 12 hours
Criteria for uncomplicated SAB (must meet all)
- exclusion of endocarditis (negative TTE, TEE)
- no implantable devices of prostheses
- follow-up blood cultures drawn 2-4 days after starting therapy are negative
- patient defervesced 48-72 hours after initiating IV therapy
- no evidence of metastatic infection
Treatment duration: bacteremia due to other GP cocci
14 days (IV -> PO)
Treatment: S. pyogenes, S. agalactiae bacteremia
Pencillin IV -> High dose amoxicillin PO
Treatment: S. pneumoniae bacteremia
ceftriaxone or penicillin
