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BCIDP > Cardiovascular Infection > Flashcards

Cardiovascular Infection Flashcards

1
Q

What are the major criteria for Duke’s criteria?

A
  • 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
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2
Q

What are the minor criteria for Duke’s criteria?

A
  • Predisposition to heart conditions
  • IVDU
  • Fever >38C
  • Vascular phenomena
  • Immunological phenomena
  • Positive blood cx that does not meet major criteria
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3
Q

What is the definition of definite IE?

A
  • 2 major criteria
  • 1 major criteria + 3 minor criteria
  • 5 minor criteria
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4
Q

What is the possible IE?

A
  • 1 major and 1 minor criteria

- 3 minor criteria

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5
Q

When do you start counting duration of therapy for IE?

A
  • 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

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6
Q

How would you treat native valve, highly PCN susceptible VGS and S. galloctyicus, MIC < 0.12?

A
  • 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
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7
Q

How would you treat native valve, VGS and S. gallolyticus with PCN MIC >0.12 to <0.5?

A
  • PCN 12-18 MU/24 hrs for 4 weeks + gentamicin for 2 weeks
  • CTX for 4 weeks
  • Vancomycin for 4 weeks
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8
Q

How would you treat native valve, A defectiva, Granulicatella spp, and VGS with PCN MIC > 0.5?

A
  • PCN 24 MU/24 hrs or CTX + Gentamicin (in divided 2-3 doses) x 4-6 weeks
  • Vancomycin x 4-6 weeks
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9
Q

How would you treat Prosthetic valve for highly PCN susceptible VGS with MIC < 0.12 mcg/mL?

A
  • PCN 24 MU/24 hrs or CTX x 6 weeks +/- gentamicin 3 mg/kg x 2 weeks
  • Vancomycin x 4-6 weeks
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10
Q

How would you treat Prosthetic valve for PCN susceptible VGS MIC > 0.12?

A

PCN or CTX + Gentamicin x 6 weeks

Vancomycin x 4-6 weeks

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11
Q

How would you treat native valve Staph spp IE in oxacillin susceptible and resistant strains?

A

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

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12
Q

How would you treat prosthetic valve staph spp IE in oxacillin susceptible or resistant strains?

A

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

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13
Q

How do you treat a native valve and PVE enterococci spp IE?

A

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

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14
Q

How do you calculate the NNT?

A

Number with adverse effect/total number of patients with adverse effects

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15
Q

How do you treat native or PVE for VRE IE?

A

Linezolid x > 6 weeks

Daptomycin +/- ampicillin or ceftaroline x > 6 weeks

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16
Q

How do you treat culture negative NVIE?

A

Acute (days): S. aureus, Strep spp, aerobic GNR: vancomycin + cefepime

Subacute (weeks): S. aureus, VGS, HACEK, Enterococcus spp: Vanco + amp/sulbactam

17
Q

How do you treat culture negative PVIE?

A

Time to symptom onset:
< 1 year (Staph spp, enterococcus spp, aerobic GNR): Vanco + gentamicin + rifampin + cefepime

> 1 year (Stph spp, VGS, enterococcus): vancomycin + CTX

18
Q

Which beta lactams require weekly LFT monitoring?

A

Nafcillin, oxacillin, carbapenem

19
Q

What monitoring requirements are needed for anti-pseudomonal PCN?

A

Weekly CBC, SCr and K

20
Q

What monitoring requirements are needed for vancomycin?

A

Weekly CBC, SCr and K

21
Q

What monitoring parameters are needed for amphotericin B?

A

Weekly CBC, biweekly SCr and K along with weekly LFT

22
Q

What cardiac conditions have the highest risk of IE and prophylaxis is reasonable?

A

Prosthetic cardiac or prosthetic material used for cardiac valve repair

Previous IE

23
Q

What dental procedures have the highest risk of IE for prophylaxis is reasonable?

A

Manipulation of gingival tissue or periapical region of teeth or perforation of oral mucosa

  • Biopsies
  • Suture removal
  • Placement of orthodontic bnd
24
Q

What are adults antibiotic prophylaxis regimens?

A

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

25
Q

What respiratory tract procedures may require prophylaxis?

A

Tonsillectomy
Adenoidectomy
Drainage of lung abscess or empyema

26
Q

What GI/GU procedures may require prophylaxis?

A

Elective cystoscopy or urinary tract manipulation and enterococcal UTI or colonization

Can use ampicillin, PCN, piperacillin or vancomycin

27
Q

How would you diagnosis cardiac implantable electronic devices?

A
  • 2 sets of blood cx prior to abx
  • TEE (TTE not as helpful)
  • Cultures from generator tissue or lead tip
28
Q

How would you treat superfiical/incisional infections?

A
  • No device involvement - removal not required

- Treat with 7-10 days of oral abx with antistaphylococcal activity

29
Q

How would you treat CIED infection with localized pocket infection, CIED erosion, infective endocarditis with valve repair in negative vs positive blood cx?

A
  • Removal of hardware
  • Empiric vancomycin
  • Duration:
  • In negative blood cx: pocket infection (10-14 days after device removal), Generator removal/lead erosion (7-10 days of abx after device removal)
  • In positive blood cx, perform TEE
  • If TEE shows lead vegetation (complicated e.g. septic thrombosis treat with 4-6 weeks of abx) vs uncomplicated (treat like TEE negative)
  • If TEE negative (non-S. aureus: treat with 2 weeks of abx) (S. aureus: treat with 2-4 weeks of abx, repeat TEE in 2 weeks)

*If positive blood cx even after CIED removal and appropriate abx, treat for 4 weeks

30
Q

What are the most common organisms for LVAD infections?

A

Staph spp
Enterococcus spp
PSA
Candida

31
Q

How should be LVAD related infections be managed?

A

Empiric therapy against Staph spp and PSA

BCIDP (13 decks)

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