Cardiovascular Infection Flashcards
What are the major criteria for Duke’s criteria?
- Blood cx positive for IE (2/2): strep viridans, strep gallolyticus, HACEK, Staph aureus, enterococci
- Positive blood cx for Coxiella burnetti or IgG > 1:800
- Evidence of endocardial involvement (i.e. abscess)
- Echocardiogram positive for IE
What are the minor criteria for Duke’s criteria?
- Predisposition to heart conditions
- IVDU
- Fever >38C
- Vascular phenomena
- Immunological phenomena
- Positive blood cx that does not meet major criteria
What is the definition of definite IE?
- 2 major criteria
- 1 major criteria + 3 minor criteria
- 5 minor criteria
What is the possible IE?
- 1 major and 1 minor criteria
- 3 minor criteria
When do you start counting duration of therapy for IE?
- Day 1 of negative blood culture is Day 1
HOWEVER, if resected valve tissue culture or perivalvular abscess found, abx should be restarted after valve surgery. If negative, abx days prior to surgery can be counted
How would you treat native valve, highly PCN susceptible VGS and S. galloctyicus, MIC < 0.12?
- PCN 12-18 million units/24 hr for 4 weeks OR
- CTX 2 g IV Q24H for 4 weeks OR
- PCN G or CTX + Gentamicin for 2 weeks OR
- vancomycin for 4 weeks
How would you treat native valve, VGS and S. gallolyticus with PCN MIC >0.12 to <0.5?
- PCN 12-18 MU/24 hrs for 4 weeks + gentamicin for 2 weeks
- CTX for 4 weeks
- Vancomycin for 4 weeks
How would you treat native valve, A defectiva, Granulicatella spp, and VGS with PCN MIC > 0.5?
- PCN 24 MU/24 hrs or CTX + Gentamicin (in divided 2-3 doses) x 4-6 weeks
- Vancomycin x 4-6 weeks
How would you treat Prosthetic valve for highly PCN susceptible VGS with MIC < 0.12 mcg/mL?
- PCN 24 MU/24 hrs or CTX x 6 weeks +/- gentamicin 3 mg/kg x 2 weeks
- Vancomycin x 4-6 weeks
How would you treat Prosthetic valve for PCN susceptible VGS MIC > 0.12?
PCN or CTX + Gentamicin x 6 weeks
Vancomycin x 4-6 weeks
How would you treat native valve Staph spp IE in oxacillin susceptible and resistant strains?
Oxacillin susceptible strains
- Nafcillin or oxacillin 12 g/24 hrs x 6 weeks
- Cefazolin 6 g/24 hrs x 6 weeks
Oxacillin resistance
Vanco x 6 weeks
Daptomycin > 8 mg/kg/day x 6 weeks
How would you treat prosthetic valve staph spp IE in oxacillin susceptible or resistant strains?
Oxacillin susceptible strains:
Nafcillin or oxacillin 12 g/24 hr + rifampin x 6 weeks + gentamicin 3 mg/kg/24 hr (in 2-3 divided doses) x 2 weeks
Oxacillin resistant strains:
Vancomycin + rifampin x 6 weeks + gentamicin 3 mg/kg/24 hr (in 2-3 divided doses) x 2 weeks
How do you treat a native valve and PVE enterococci spp IE?
Ampicillin 2 g IV Q4 H or PCN G 18-30 MU/24 hrs x 4-6 weeks + Gentamicin 3 mg/kg (in 2-3 divided doses)
*4 week therapy: symptoms < 3 months, 6 weeks if symptoms > 6 months or PVE
Ampicillin 2 g IV Q4h + CTX 2 g IV Q12H x 6 weeks
Vancomycin + gentamicin x 6 weeks
How do you calculate the NNT?
Number with adverse effect/total number of patients with adverse effects
How do you treat native or PVE for VRE IE?
Linezolid x > 6 weeks
Daptomycin +/- ampicillin or ceftaroline x > 6 weeks
How do you treat culture negative NVIE?
Acute (days): S. aureus, Strep spp, aerobic GNR: vancomycin + cefepime
Subacute (weeks): S. aureus, VGS, HACEK, Enterococcus spp: Vanco + amp/sulbactam
How do you treat culture negative PVIE?
Time to symptom onset:
< 1 year (Staph spp, enterococcus spp, aerobic GNR): Vanco + gentamicin + rifampin + cefepime
> 1 year (Stph spp, VGS, enterococcus): vancomycin + CTX
Which beta lactams require weekly LFT monitoring?
Nafcillin, oxacillin, carbapenem
What monitoring requirements are needed for anti-pseudomonal PCN?
Weekly CBC, SCr and K
What monitoring requirements are needed for vancomycin?
Weekly CBC, SCr and K
What monitoring parameters are needed for amphotericin B?
Weekly CBC, biweekly SCr and K along with weekly LFT
What cardiac conditions have the highest risk of IE and prophylaxis is reasonable?
Prosthetic cardiac or prosthetic material used for cardiac valve repair
Previous IE
What dental procedures have the highest risk of IE for prophylaxis is reasonable?
Manipulation of gingival tissue or periapical region of teeth or perforation of oral mucosa
- Biopsies
- Suture removal
- Placement of orthodontic bnd
What are adults antibiotic prophylaxis regimens?
Oral: Amoxicillin 2 g
Unable to take orals: Ampicillin 2 g or cefazolin 1 g or CTX 1 g
Allergic to PCN (oral): Cephalexin 2 g or clindamycin 600 mg or azithro or claritho 500 mg
Allergic to PCN and unable to take orals: Cefazolin or CTX or clinda 600 mg IV
*Directed to strep sp
