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
