endocarditis Flashcards
Endocarditis gram + microbe coverage
S. aureus, S. epidermidis, S. lugdunesis
Oral Strep (viridans), S anginosus, S. milleri, S. bovis
Enterococci
Endocarditis gram - microbe coverage
Enterobacteriacaea, P. aeruginosa, HACEK
Osler Node
on digits, very painful, secondary to immune complexes
Splinter Hemmorrhages
look like splinters in finger and toenails; thought to be microemboli
Petechiae
found in multiple places across body (mucosa, trunk area); occurs 20-40% of the time
Janeway lesions
Painless, seen in patients with acute endocarditis; on palms and soles
Roth spots
very suggestive of IE, do not occur frequently, retinal hemorrhages
clubbing
on digits; longstanding infection
“From Jane”
Fever, Roth Spots, Osler nodes, Murmer. Janeway lesions, Anemia, Nail hemorrhages, Emboli
Clinical Diagnostic criteria
2 Major criteria: positive echocardiography + persistent bacteremia with IE pathogens
Native Valve - Highly Susceptible Streptococci
PCN G(12-18 M units/24 hr) OR ceftriaxone 2g/24hr +/- 2 week gentamicin: 2-4 weeks
Prosthetic Valve - Highly Susceptible Streptococci
Same as Native Valve - Highly Susceptible except PCN G dose = 24 M units/24 hr + mandatory 2 week gentamicin:
6 week
Native Valve - Relatively Resistant Streptococci
Same as Native Valve - Highly Susceptible except PCN G dose = 24 M units/24 hr + mandatory 2 week gentamicin:
4 week
Prosthetic Valve - Relatively Resistant Streptococci
Same as Native Valve - Highly Susceptible except PCN G dose = 24 M units/24 hr + mandatory 6 week gentamicin:
6 week
Native Valve - Highly Resistant Streptococci
ampicillin (12g/24 hr) OR PCN G(18-30 M units/24 hr) + 4-6 week gentamicin OR ceftriaxone:
4-6 week
Prosthetic Valve - Highly Resistant Streptococci
Same as Native Valve - Highly Resistant Streptococci:
6 week
Native Valve Beta lactam susceptible Enterococci
same as Native Valve - Highly Resistant Streptococci:
4-6 week
Prosthetic Valve Beta lactam Susceptible Enterococci
Native Valve - Highly Resistant Streptococci:
6 week
Enterococci - Beta lactam Resistant
linezolid, quinupristin/dalfopristin, daptomycin
Enterococci - gentamicin resistant
Ampicillin or PCN G PLUS streptomycin OR ceftriaxone:
4 - 6 weeks
Native valve - MSSA
nafcillin (12g/24hr)
alternate - cefazolin
6 week
prosthetic valve - MSSA
nafcillin + rifampin (900 mg/24hr) + 2 week gentamicin:
>6 week
Native valve - MRSA
vancomicin:
6 week
Prosthetic valve - MRSA
Vancomicin + rifampin (900mg/24hr) + 2 week gentamicin:
>6 week
HACEK treatment
ceftriaxone 2g/24hr OR ampicillin/sulbactam 12g/day
alternate - ciprofloxacin:
4 week
HACEK pathogens
Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella corrodens, Kingella