Endocarditis

Question 1

Healthcare-associated endocarditis

Answer 1

diagnosis is made >72 hours after admission without evidence of endocarditis on admission

endocarditis develops within 6 months after hospital discharge

endocarditis develops within 6 months of cardiovascular manipulations including central venous catheter use, arteriovenous fistula for hemodialysis
invasive intravascular techniques, or intracardiac devices such as pacemakers and left ventricular assist devices.

Question 2

Cases with onset within 60 days after surgery are termed ____________ and are usually nosocomial

Answer 2

early prosthetic valve endocarditis

Question 3

Cases starting beyond 60 days after surgery are termed __________________and are usually community acquired.

Answer 3

late prosthetic valve endocarditis

Question 4

True or false

Hospital mortality rates are highest for those with early (30% to 80%) versus late (20% to 40%) prosthetic valve endocarditis, attributable to the greater virulence of the causative organisms involved.

Answer 4

True

Question 5

What drug use is particularly associated with endocarditis

Answer 5

cocaine

Question 6

Nonbacterial thrombotic vegetations (also called___________________) can result from hypercoagulable states, malignancy, or SLE and in areas surrounding foreign bodies (vascular catheters or prosthetic valves).

Answer 6

marantic endocarditis

Question 7

Libman-Sacks endocarditis

Answer 7

SLE endocarditis

Question 8

Transient bacteremia (as little as ___________) may colonize and convert to infective endocarditis.

Answer 8

10 organisms per milliliter of blood for <30 minutes

Question 9

Infective Endocarditis

________________is the single most common cause, followed by __________________ (including viridans group streptococci) and enterococci

Answer 9

Staphylococcus

streptococci

Question 10

What valves are affected in patients who are IV drug abusers

Answer 10

tricuspid

Question 11

Early prosthetic valve endocarditis is most commonly caused by perioperative colonization from (3)

Answer 11

Staphylococcus epidermidis,
Aspergillus, or
Candida albicans.

Question 12

For culture- negative cases without prior antibiotic administration, infection is most often due to fastidious organisms like

Answer 12

(usually from the HACEK group— Haemophilus , Aggregatibacter, Cardiobacterium, Eikenella, and Kingella— and also Bartonella and Coxiella burnetii)

Question 13

small, tender subcutaneous nodules on the pads of the digits

Answer 13

Osler nodes

Question 14

small hemorrhagic painless plaques on the digits

Answer 14

Janeway lesions

Question 15

True or false

Suspicion of endocarditis usually requires hospital admission

Answer 15

True

Question 16

True or false

Admit patients with a cardiac prosthetic valve and fever (or persistent malaise, vasculitis, or new murmur) given the high morbidity and mortality associated with prosthetic valve infection

Answer 16

True

Question 17

True or false

In stable patients with a low suspicion of endocarditis who were initially discharged, admit immediately once positive blood cultures result.

Answer 17

True

Question 18

True or false

Answer 18

Obtain blood cultures (at least 10 mL per culture bottle) before beginning antibiotics.

Question 19

True or false

Draw three sets from separate sites because fewer collections may not detect bacteremia.

Answer 19

True

Question 20

True or false

Ideally, wait at least 1 hour between the first and last blood culture.

Answer 20

True