Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

therapeutics V > Bloodstream/Catheter-related Infections & Infective Endocarditis > Flashcards

Bloodstream/Catheter-related Infections & Infective Endocarditis Flashcards

1
Q

Bacteremia

A

presence of viable bacteria in the bloodstream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bacteremia Causes

A

-focal infections
-indwelling devices
-medical procedure
-oral hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bacteremia Complications

A

SIRS, metastatic secondary foci, infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk Factors for Bacteremia

A

-advanced age
-chronic liver disease
-diabetes
- ESRD on dialysis
-asplenia
- HIV
-immunosuppressive therapy
- indwelling prostheses
- iv drug use
- malignancies
- malnutrition
- neutropenia
-PAD
- steroid use
- recent procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Bacteremia Diagnosis

A

detection of organism from at least two blood cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Infective Endocarditis

A

inflammation/ infection of the endocardium, typically involving heart valves, caused by microorganisms entering the bloodstream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute IE

A

rapid, severe, S. aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Subacute IE

A

indolent, less virulent organisms, preexisting valve disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

prosthetic valve endocarditis

A

type of IE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cardiac implantable electronic device related IE

A

type oF IE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

IE Pathogenesis

A

-endothelial damage
-platelet/fibrin deposition
-bacteremia with adherence to endothelial surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

IE Vegetations

A

bacterial colonies protected from antimicrobials and host defenses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of IE

A

-local perivalvular damage
-embolization of septic fragments
-formation of antibody complexes
-valvular tissue destruction
- acute heart failure
-abscesses
-conduction abnormalities
-septic emboli
-mycotic aneurysms
-glomerulonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Diagnosis of IE

A

clinical, labs, and echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DUKE criteria

A

Major Criteria:
- blood cultures positive
- evidence of endocardial involvement
Minor Criteria:
-predisposing factor
- temp >38C
- immunologic phenomena
-microbiological evidence
-vascular phenomena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Duke criteria diagnosis

A

two major or one major + three minor or five minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

IE Risk Factors

A

-congenial heart disease
-advanced age
-chronic iv access
- diabetes
-rheumatic heart disease
-cardiac implant device
-chronic heart failure
- mitral valve prolapse w/regurgitation
-iv drug use
- HIV
- poor dental hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Common organisms IE

A

Staph aureus , streptococci, enterococci, HACEK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Viridans Streptococci

A

highly susceptible to Pen G

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Empiric therapy for IE

A

vanc or daptomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Duration of Therapy IE

A

depends on organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Antimicrobial Prophylaxis IE

A

pts whit high risk cardiac conditions undergoing procedures associated w/ bacteremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

procedures requiring prophylaxis IE

A

dental procedures, invasive respiratory procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Prophylaxis IE Regimen

A

2g dose of amoxicillin 30-60min before the procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are vegetations
colonies of bacteria on heart valves, protected from antimicrobials cause valve damage, embolization, and systemic complications
26
How does IE affect the heart?
affects heart valves
27
IE Follow up
blood cultures every 24-48h until sterile
28
Staphylococcus aureus bacteremia
leading cause of community acquired and hospital acquired bacteremia
29
Clinical manifestations of endocarditis
-osler nodes -janeway lesions -splinter hemorrhages -petechiae -roth spots
30
SAB Diagnosis
-blood cultures (repeat every 48-72h until negative) -Echo -> TTE first -> TEE after
31
S.aureus in urine cultures in bacteremia
-not common - associated w/ increased mortality
32
Empiric tx of S. aureus bacteremia
-source control and abx -vanc -daptomycin
33
Tx of MSSA
-nafcillin -oxacillin -cefazolin
34
SAB Treatment Combo therapy?
Van or dapt plus beta lactam
35
SAB duration of treatment
uncomplicated -> 14 days from last negative blood culture complicated -> 4 weeks complicated w/ metastatic -> 6-8 weeks IV therapy for full duration
36
Streptococci Bacteremia Tx duration
14 days (iv -> po)
37
streptococci bacteria common bacteria
-viridans strept -strep gallolyticus
38
Streptococci Bacteremia Treatment
- high dose amox po -> s. pyogens, s. agalactiae -S. pnemoniae -> ceftriaxone or pencillin
39
Enterococci Bacteremia causative organisms
-e. faecalis - e faecium
40
Enterococci bacterium treatment duration
7 days
41
E. faecalis Bacterium Treatment
-ampicillin (1st line) - 2nd line : vanc or dapto
42
E. faexium Bacteremia Treatment
- if vanA and vanB negative -> vancomycin - vanA or VanB -> daptomycin, linezolid
43
Treatment of uncomplicated gram - bacteremia
depends on the organism -po -> tmp/smz, fq, beta lactam
44
Treatment duration uncomplicated gram - bacteremia
7 days
45
Enterobacteriaceae Bacteremia Treatment Duration
longer duration not always better 10 days
46
Abx therapy duration for P. aeruginosa bacteremia
-short curse is better -9 days
47
What is bacteremia?
The presence of viable bacteria in the bloodstream.
48
What are common causes of bacteremia?
Focal infections, indwelling devices, procedures, or unknown sources.
49
What are complications of bacteremia?
SIRS, infective endocarditis, and metastatic infections.
50
How is bacteremia diagnosed?
At least 2 sets of blood cultures (aerobic and anaerobic).
51
Why are follow-up blood cultures important in bacteremia?
To assess clearance and guide therapy.
52
What is infective endocarditis (IE)?
Infection of the endocardium, often involving the heart valves.
53
What are the types of IE?
Acute, subacute, prosthetic valve IE, and device-related IE.
54
What is the Modified Duke Criteria?
A set of major and minor clinical, microbiologic, and imaging findings to diagnose IE.
55
What are the major Duke criteria?
Positive blood cultures and evidence of endocardial involvement (e.g., vegetation on echo).
56
What organisms most commonly cause IE?
Staphylococci, Streptococci, Enterococci, HACEK organisms.
57
What is empiric therapy for suspected IE?
Vancomycin + ceftriaxone until organism is identified.
58
What antibiotics treat MRSA bacteremia?
Vancomycin or daptomycin.
59
What is the preferred treatment for MSSA bacteremia?
Nafcillin, oxacillin, or cefazolin (better than vancomycin).
60
What is the typical duration of therapy for IE?
Usually 4–6 weeks depending on organism and valve involvement.
61
Who should receive IE prophylaxis?
Patients with prosthetic valves, prior IE, some congenital heart diseases.
62
What procedures require IE prophylaxis?
Dental, respiratory, or infected skin/muscle procedures in high-risk patients.
63
What is the recommended prophylactic regimen?
Amoxicillin 2 g PO 30–60 minutes before procedure.
64
What are vegetations in IE?
Masses of platelets, fibrin, microorganisms, and inflammatory cells on heart valves.
65
What are signs of embolic complications from IE?
Splenic infarcts, stroke, renal infarction, Janeway lesions, Osler nodes.
66
What is the treatment duration for uncomplicated MSSA bacteremia?
At least 14 days from first negative blood culture, if no endocarditis or metastatic sites.
67
What is the treatment duration for complicated MSSA/MRSA bacteremia or IE?
4–6 weeks depending on valve involvement and site of infection.
68
How long is treatment for Streptococcus viridans IE on native valves?
4 weeks of penicillin G or ceftriaxone; can be shortened to 2 weeks with gentamicin if criteria met.
69
What is the treatment duration for Enterococcus endocarditis?
4–6 weeks with ampicillin + ceftriaxone or ampicillin + gentamicin depending on resistance and renal function.
70
Can oral step-down therapy be used in bacteremia or endocarditis?
Yes, in carefully selected stable patients without endocardial involvement; regimens include linezolid, fluoroquinolones, or TMP-SMX based on susceptibilities.
71
What oral agents have good bioavailability for oral step-down in Gram-positive bacteremia?
Linezolid, fluoroquinolones (e.g., levofloxacin), TMP-SMX, doxycycline, clindamycin.
72
What is a key difference in treating MSSA vs MRSA bacteremia?
MSSA responds better to beta-lactams like nafcillin or cefazolin than to vancomycin.
73
Why is vancomycin preferred over daptomycin in IE caused by MRSA with pneumonia?
Daptomycin is inactivated by lung surfactant; vancomycin is used for pneumonia.
74
When is echocardiography indicated in bacteremia?
Always consider in Staph aureus bacteremia or persistent bacteremia to rule out endocarditis.
75
What imaging modality is preferred for detecting vegetations in IE?
Transesophageal echocardiogram (TEE) is more sensitive than transthoracic (TTE).
76
What are key criteria to classify bacteremia as uncomplicated?
Follow-up cultures negative in 2–4 days, resolution of fever in 72 hours, no metastatic sites, catheter removal if source, not endocarditis.
77
What are signs of complicated bacteremia?
Persistent positive cultures, fever >72h, metastatic infection, endocarditis, retained hardware, or indwelling devices.
78
What tests are essential in evaluating bacteremia?
At least 2 sets of blood cultures, source control evaluation, echocardiography, and symptom monitoring.
79
What are the most common organisms causing bloodstream infections?
Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus, E. coli, Klebsiella, Pseudomonas, Candida spp.
80
What are minor Duke criteria for endocarditis?
Fever ≥38°C, predisposing condition, vascular or immunologic findings, or positive cultures not meeting major criteria.
81
What organism is most associated with injection drug use endocarditis?
Staphylococcus aureus, often affecting the tricuspid valve.
82
Which valve is most commonly affected in native valve endocarditis?
Mitral valve.
83
What organisms in blood cultures should generally be considered contaminants?
Coagulase-negative staph (if only 1 culture positive), Corynebacterium spp., Bacillus spp., Propionibacterium acnes (unless clinical suspicion).
84
When is echocardiography most indicated in bacteremia?
S. aureus bacteremia, Enterococcus, persistent bacteremia, or signs of embolic phenomena.
85
What are key components of bacteremia follow-up?
Repeat blood cultures, symptom tracking, source control, monitor renal function and antibiotic levels if needed.

therapeutics V (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions