endocarditis

Question 1

Endocarditis gram + microbe coverage

Answer 1

S. aureus, S. epidermidis, S. lugdunesis
Oral Strep (viridans), S anginosus, S. milleri, S. bovis
Enterococci

Question 2

Endocarditis gram - microbe coverage

Answer 2

Enterobacteriacaea, P. aeruginosa, HACEK

Question 3

Osler Node

Answer 3

on digits, very painful, secondary to immune complexes

Question 4

Splinter Hemmorrhages

Answer 4

look like splinters in finger and toenails; thought to be microemboli

Question 5

Petechiae

Answer 5

found in multiple places across body (mucosa, trunk area); occurs 20-40% of the time

Question 6

Janeway lesions

Answer 6

Painless, seen in patients with acute endocarditis; on palms and soles

Question 7

Roth spots

Answer 7

very suggestive of IE, do not occur frequently, retinal hemorrhages

Question 8

clubbing

Answer 8

on digits; longstanding infection

Question 9

“From Jane”

Answer 9

Fever, Roth Spots, Osler nodes, Murmer. Janeway lesions, Anemia, Nail hemorrhages, Emboli

Question 10

Clinical Diagnostic criteria

Answer 10

2 Major criteria: positive echocardiography + persistent bacteremia with IE pathogens

Question 11

Native Valve - Highly Susceptible Streptococci

Answer 11

PCN G(12-18 M units/24 hr) OR ceftriaxone 2g/24hr +/- 2 week gentamicin:
2-4 weeks

Question 12

Prosthetic Valve - Highly Susceptible Streptococci

Answer 12

Same as Native Valve - Highly Susceptible except PCN G dose = 24 M units/24 hr + mandatory 2 week gentamicin:
6 week

Question 13

Native Valve - Relatively Resistant Streptococci

Answer 13

Same as Native Valve - Highly Susceptible except PCN G dose = 24 M units/24 hr + mandatory 2 week gentamicin:
4 week

Question 14

Prosthetic Valve - Relatively Resistant Streptococci

Answer 14

Same as Native Valve - Highly Susceptible except PCN G dose = 24 M units/24 hr + mandatory 6 week gentamicin:
6 week

Question 15

Native Valve - Highly Resistant Streptococci

Answer 15

ampicillin (12g/24 hr) OR PCN G(18-30 M units/24 hr) + 4-6 week gentamicin OR ceftriaxone:
4-6 week

Question 16

Prosthetic Valve - Highly Resistant Streptococci

Answer 16

Same as Native Valve - Highly Resistant Streptococci:

6 week

Question 17

Native Valve Beta lactam susceptible Enterococci

Answer 17

same as Native Valve - Highly Resistant Streptococci:

4-6 week

Question 18

Prosthetic Valve Beta lactam Susceptible Enterococci

Answer 18

Native Valve - Highly Resistant Streptococci:

6 week

Question 19

Enterococci - Beta lactam Resistant

Answer 19

linezolid, quinupristin/dalfopristin, daptomycin

Question 20

Enterococci - gentamicin resistant

Answer 20

Ampicillin or PCN G PLUS streptomycin OR ceftriaxone:

4 - 6 weeks

Question 21

Native valve - MSSA

Answer 21

nafcillin (12g/24hr)
alternate - cefazolin
6 week

Question 22

prosthetic valve - MSSA

Answer 22

nafcillin + rifampin (900 mg/24hr) + 2 week gentamicin:

>6 week

Question 23

Native valve - MRSA

Answer 23

vancomicin:

6 week

Question 24

Prosthetic valve - MRSA

Answer 24

Vancomicin + rifampin (900mg/24hr) + 2 week gentamicin:

>6 week

Question 25

HACEK treatment

Answer 25

ceftriaxone 2g/24hr OR ampicillin/sulbactam 12g/day alternate - ciprofloxacin: 4 week

Question 26

HACEK pathogens

Answer 26

Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella corrodens, Kingella