Endocarditis Flashcards
What criteria must be met to diagnose endocarditis?
-2 major criteria
-5 minor criteria
-1 major and 3 minor criteria
What are the three major criteria for diagnosing endocarditis?
-Microbiological
-Imaging
-Surgical
How can you microbiologically diagnose endocarditis?
-Positive blood cultures
-Positive laboratory tests (never really used)
What imaging tools are used to diagnose endocarditis?
Endocardiography and CT imaging showing vegetation
How is endocarditis diagnosed using surgery?
By looking at it
Generally how long is treatment of endocarditis?
-Shortest duration is 2 weeks but 4-6 weeks or longer may be needed
-Begin counting days of treatment on first day of negative blood cultures
Treatment options for penicillin susceptible strep endocarditis
-Penicillin G +/- gentamicin
-Ceftriaxone +/- gentamicin
-Vancomycin (unable to tolerate beta-lactams)
Treatment options for penicillin resistant strep endocarditis
-Penicillin G + gentamicin
-Ceftriaxone + gentamicin
-Vancomycin (unable to tolerate beta-lactams)
Treatment options for MSSA endocarditis
-Nafcillin
-Oxacillin
-Cefazolin
Treatment options for MRSA endocarditis
-Vancomycin
-Daptomycin for right-sided IE only
When would you use ceftaroline in MRSA endocarditis?
Salvage therapy when first-line therapy does not work and patient is not improving
What medication would be added to the treatment of MRSA/MSSA endocarditis?
Rifampin and gentamicin
Treatment options for penicillin- and aminoglycoside-susceptible enterococci endocarditis
-Ampicillin + gentamicin
-Penicillin + gentamicin
-Ampicillin + ceftriaxone
Treatment options for penicillin-susceptible and aminoglycoside-resistant enterococci endocarditis
Penicillin + ceftriaxone
Treatment options for patients unable to tolerate beta-lactam therapy in enterococci endocarditis
Vancomycin + gentamicin
Treatment options for VRE endocarditis
-Daptomycin
-Linezolid
Treatment options for HACEK endocarditis
-Ceftriaxone
-Unasyn
-Ciprofloxacin
Treatment for fungal endocarditis
-Amphotericin B + flucytosine for more than 6 weeks
-May require life-long suppressive therapy with oral fluconazole
What is a leading cause of culture negative endocarditis?
Previous administration of antimicrobial agents before blood cultures
Treatment options for culture-negative endocarditis
-Vancomycin + cefepime
-Unasyn + vancomycin
Endocarditis monitoring parameters
-Fever
-Blood cultures and susceptibilities
-Therapeutic drug monitoring
-Adverse events
When are antibiotics recommended for prophylaxis treatment of endocarditis?
Before dental procedures in select patients
