Cardiovascular Infections Flashcards
Risk ion endocarditis in PVE
Prosthetic heart valves i. IE occurs in 1%–6% of patients after surgical valve replacement. ii. Greatest risk occurs in the first 3 months after surgery.
Duke major criteria
Typical organism from 2 separate BCx
Persistently positive cx (>12 h apart(
Positive echo
Duke minor criteria
Fever
Hx of IVDU or valve condition
Vascular phenomenon (arterial emboli, PE, Janeway lesion)
Immunologic phenomenon (Oiler nodes, Roth spots)
BCx for non-typical organism
Number of Duke criteria for IE do
Definite IE: Two major clinical criteria; one major criterion and three minor criteria; or five minor criteria b. Possible IE: One major criterion and one minor criterion; or three minor criteria
Management of uncomplicated R-side IE in IDU
Right-sided IE in IDU (a) Short-course therapy with a β-lactam or daptomycin can be considered in patients with uncomplicated disease. (1) Gentamicin is no longer recommended because of growing evidence that β-lactam monotherapy has efficacy similar to combination therapy in these patients.
Treatment of viridans strep native valve IE
<0.12: PCN or CTX x4 weeks or (PCN or CTX) + gent x2 weeks
0.12-0.5: PCN x4 weeks+ gent x2 weeks
>0.5: PCN + gent x4-6 weeks
Treatment of prosthetic valve viridans strep IE
PCN MIC <=0.12: pcn or CTX x6 weeks
PCN MIC >0.12: PCN or CTX x6 weeks + gent x6 weeks
Indications for surgical intervention in IE
Indications for surgical intervention
i. Vegetation: Persistent vegetation after systemic embolization; large (greater than 10 cm)
anterior mitral leaflet vegetation; one or more embolic events during the first 2 weeks of anti-
microbial therapy; increase in vegetation size despite appropriate antimicrobial therapy
ii. Valvular dysfunction: Acute aortic or mitral valve insufficiency with signs of ventricular dys-
function; heart failure unresponsive to medical therapy
iii. Valve perforation or rupture: Perivalvular extension; valvular dehiscence, rupture, or fis-
tula; new heart block; large abscess or extension of abscess despite appropriate antimicrobial
therapy
iv. Causative organism: Non-HACEK gram-negative organism, fungi, and multidrug-resistant
organisms; S. aureus in PVE with an intracardiac complication
Groups for prophylaxis before invasive dental procedures
No data show that antimicrobial prophylaxis before invasive dental procedures prevents IE epi- sodes. Prophylaxis should be reserved for the highest-risk groups: i. Prosthetic cardiac valve ii. Previous IE iii. Congenital heart disease iv. Cardiac transplant recipients with cardiac valvulopathy b. Prophylaxis is indicated for all dental procedures that involve manipulation of the gingival tissue or periapical region or perforation of the oral mucosa. c.
Antibiotic timing and selection in dental pox
Treatment should be directed against viridans group streptococci. Single dose given 30–60 min- utes before dental procedure i. Preferred oral therapy; see Table 3 for dosing (a) Amoxicillin (b) If intolerant of penicillin – Cephalexin, clindamycin, azithromycin, or clarithromycin
Treatment durations for ICD infections with device removal
guidelines recommend the following dura- tions assuming device removal: i. Infections limited to the pocket site without evidence of inflammatory changes: 7–10 days ii. Infections limited to pocket site with inflammatory changes: 10–14 days iii. If blood cultures are positive: At least 2 weeks
Etiology of pericarditis
In developed countries, 80%–90% of pericarditis is idiopathic; often presumed to be viral in first occurrences a. Viral pathogens: HIV, influenza, varicella, Epstein-Barr virus, adenovirus, echovirus, coxsackie- virus, cytomegalovirus, mumps, parvovirus B19, rubella. Purulent pericarditis accounts for less than 1% of cases and is often the result of an extended infection from an alternative source (i.e., pneumonia).
Management of viral pericarditis
Clinical evidence is lacking to support antiviral treatment when viral pericarditis is suspected. b. Treatment is directed at anti-inflammatory agents to control inflammation. i. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of therapy
Etiology of myocarditis
MYOCARDITIS A. Etiology 1. Cause is often unknown. 2. Viruses are the most common infectious etiology with enteroviruses, such as Coxsackie B virus, ade- novirus, hepatitis C virus, cytomegalovirus, influenza, or Epstein-Barr virus.
Management of myocarditis
Treatment (Domain 1, Task 4): Given the viral etiology and difficulty in diagnosis, literature is lacking to guide therapy, and antiviral treatment is not routinely recommended
