D Allen Flashcards
what is the leading cause of community acquired and hospital acquired bacteremia
staph aureus
mortality rates with MRSA
20-40% - highest
is treatment failure common in SAB
yes especially with MRSA
ID consults result in what
decreased mortality
fewer relapses
decreased readmission rates
when do we take blood cultures in SAB
repeat blood cultures q48-72 hours
2 sets
what is treatment day 0
start counting SAB treatment on first day of negative cultures
what is TEE and TTE
TTE - transthoracic echocardiography
TEE - transesophageal echocardiograph
TEE performed when
in SAB after TTE
more sensitive for identifying vegetation size/location
what if we see staph aureus in the urine
not a common organism, should take blood cultures for staph bc its probably coming from somewhere else
staph aureus in urine associated with what
increased mortality
what to do with catheters/devices in SAB
assume all are infected until infection ruled out
remove asap and if u cant then add rifampin
when can we replace catheters in SAB
blood cultures negative for 48-72 hours
empiric treatment of SAB
vancomycin 15-20 mg/kg IV q 8-12 h
daptomycin 6-10 mg/kg IV q24h
- add MSSA coverage only if critical condition
MRSA bacteremia treatment
vancomycin 15-20 mg/kg IV q8-12h
daptomycin 6-10 mg/kg IV q24h
can we add gentamicin or rifampin to MRSA SAB
no don’t add on
MSSA bacteremia treatment
nafcillin 2 g IV q4h
oxacillin 2 g IV q4h
cefazolin 2 g IV q8h
MRSA bacteremia treatment if severly ill high risk treatement failure and death
vancomycin/daptomycin + MSSA drug
for first 7 days then monotherapy
uncomplicated SAB defined as what
negative TEE,TTE
no devices or prosthesis
negative blood cultures
no evidence of metastatic
SAB duration
uncomp:14 days of IV therapy from first negative blood culture
complicated: 4 weeks
complicated w metastatic: 6-8 weeks
can we use PO for SAB
use IV for full duration of treatment
biggest risk factor for SAB relapse
implantable devicie
streptococci bacteremia pathogens and risk endocarditis
high risk: viridans
low risk: pyogenes, pneumo, agilactiae
treatment duration strep bacteremia
14 days IV to PO
treatment strep bacteremia
pyogenes/agalactiae: penicilliin q4h or CI then amoxicillin PO
pneumoniae: ceftriaxone or penicillin
treatment bacteremia enterococci
e faecalis: ampicillin 2 g q4h or 12 g CI
- if amp resist or penicllin allergy: vanc or dapto
e faecium: vancomycin
- if van a/b positive: daptomyciin 10 mg/kg, linezolid
treatment uncomplicated gram neg duration
7 days total
don;t have to repeat blood cultures
can we use PO in bacteremia treatment
not staph but for gram negatives yes
PO treatment bacteremia uncomplicated gram neg
TMP/SMZ,
FQ
beta lactam
highest risk factors for endocarditis include
presence of prosthetic valve
history of endocarditis
most common organisms in endocarditis
staph aureus - people who inject drugs
viridans strep - underlying cardiac abnormalities
enterococci - abnormal heart valves
HACEK
fungi - after CV surgery or prolonged IV/antibiotic therapy
most common symptom of endocarditisi
fever
most important lab test for endocarditis
blood cultures
get 3 sets from diferent sites then 2 sets q 2-3 days
what duke criteria do we need for endocarditis diagnosis
2 major
1 major + 3 minor
5 minor
major Duke criteria
positive blood cultrues from 2+ sets
positive lab test
imaging
surgical inspection
minor criteria DUKE
previos history of IE
prosthetic valve
previous valve repair
congenital heart disease
regurgitation or stenosis
cardiac implant device
obstructive cardiomyopathy
inject drug use
endocarditis treatment viridans strep native
penicllin suseptible MIC <0.12
penicillin G 12-18 mil OR ceftriaxone x 4 weeks
penicillin G 12-18 mil+/- gentamicin x 2 weeks
ceftriaxone +/- gentamicin x 2 weeks
vancomycin x 4 weeks
endocarditis treatment viridans strep native
penicillin relatively resistant MIC 0.12-0.5
penicillin G 24 mil x 4 weeks
+
gentamicin x 2 weeks
ceftriaxone x 4 weeks
+
gentamicin x 2 weeks
vancomycin x 4 weeks
endocarditis treatment viridans strep prosthetic
penicillin suseptible MIC <0.12
penicillin G 24 mil x 6 weeks
+/-
gentamicin x 2 weeks
ceftriaxone x 6 weeks
+/-
gentamicin x 2 weeks
vancomycin x 6 weeks
alternative to penicillin G in strep treatment
ampicillin
endocarditis treatment viridans strep prosthetic
penicillin relatively resistant (MIC > 0.12)
penicillin G x 6 weeks
+
gentamicin x 6 weeks
ceftriaxone x 6 weeks
+
gentamicin x 6 weeks
vancomycin x 6 weeks if beta lactam allergy
endcarditis treatment staph aureus native
oxacillin suseptible (mssa)
nafcillin/oxacillin x 6 weeks
OR
cefazolin x 6 weeks if PCN rash
(if uncomplicated right sided can do 2 weeks)
endocarditis treatment staph aureus native
oxacillin resistant
vancomycin x 6 weeks
daptomycin 8mg/kg + x 6 weeks
daptomycin dosing in endocarditis with MRSA
8 mg/kg +
endocarditis treatment staph aureus prosthetic
oxacillin susceptible
nafcillin/oxacillin x 6 weeks
+
rifampin x 6 weeks
+
gentamicin x 2 weeks
endocarditis treatment staph aureus prosthetic
oxacillin resistant
vancomycin x 6 weeks
+
rifampin x 6 weeks
+
gentamicin x 2 weeks
endocarditis treatment enterococci prosthetic or native
penicillin and gentamicin susceptible
ampicillin + gentamicin x 4-6 weeks
penicillin + gentamicin x 6 weeks
ampicillin + ceftriaxone x 6 weeks use if CrCl < 50
endocarditis treatment enterococci prosthetic or native
penicillin susceptible, aminoglycoside resistant
ampicillin + ceftriaxone x 6 weeks
endocarditis treatment enterococci prosthetic or native
penicillin susceptible gentamicin resistant, streptomycin suseptible
ampicillin + streptomycin x 46 weeks
penicllin + streptomycin x 4-6 weeks
endocarditis tratment enterococci prosthetic or native
penicillin allergy or resistance
vancomycin + gentamycin x 6 weeks
endocarditis treatment enterococci prosthetic or native if you cant use anything else
daptomycin x 6 weeks
linezolid x 6 weeks
HACEK organisms endocarditis treatments
ceftriaxone
ampicillin / sulbactam
ciprofloxacin
4 weeks native
6 weeks prosthetic
if pseudomonas or e coli what to do in endocarditis
surgery and long term antibiotics
fungal endocarditis treatment
fluconaole > 6 weeks
what does it mean if we have culture negative endocarditis
likley gave the drugs before we got a culture
treatment of culture negative endocarditis native
vancomycin + cefepime if acute onset (days)
vancomycin + amp/sulbactam if subactute (weeks)
4-6 weeks
treatment of culture negative endocarditis prosthetic < 1 year
vancomycin x 6 weeks
gentamycin x 2 weeks
rifampin x 6 weeks
cefepime x 6 weeks
treatment of culture negative endocarditis prosthetic > 1 year
vancomycin x 6 weeks
ceftriaxone x 6 weeks
treatment of culture negative endocarditis suspected bartonella
ceftriaxone x 6 weeks
gentamicin x 2 weeks
+/- doxycycline x 6 weeks
treatmentof culture negative endocarditis documented bartonella (positive culture)
doxycycline x 6 weeks
gentamicin x 2 weeks
monitoring for endocarditis
fever
blood cultures and susceptibilities every 24-48 h
