Endocarditis Flashcards
Describe pathophysiology of endocarditis
Infxn results from colonization of damaged valvular endothelium by circulating bacteria with specific adherence properties
Endocarditis is more likely in…
2x more likely in Men
Age > 50
Endothelial damage may result from…
- jet-lesions due to turbulent blood flow
- electrodes
- catheters
- repeated IV injections of solid particles in IVDA
Which side of heart is more likely in IVDA?
Right
Which side of heart is more likely in Community-associated and healthcare acquired?
Left
Which side of heart is more likely to have a high mortality rate?
Left
Which side of heart is frequently associated with embolic stroke?
Left
Which side of heart is surgical benefits greatest in early phase of IE?
Left
Which side of heart involves the aortic and mitral(bicuspid) valves?
Left
Which side of heart involves the tricuspid valve?
Right
Which side of heart is septic pulmonary embolism more common?
Right
Which valve is rarely involved in IE?
Pulmonary Valve
Which side of heart has higher IE cure rates (>85%)?
Right
Which side of heart is IE surgery rarely indicated?
Right
RFs of IE…
Prosthetic Valve/Implant Previous IE Congenital Heart Dz Chronic IV Diabetes Healthcare related exposure Acquired valvular dysfunction CHF Mitral valve prolapse with regurgitation IV drug abuse
Most common pathogens in IE…
Staph
Strep
Enterococcus
What is the most common pathogen in IVDA?
S. aureus
S. Aureus is coagulase ___ .
Positive
Coagulase ___ ______ is more common in prosthetic valve endocarditis.
Negative staph
also staph. aureus (coagulase positive)
Most common IE pathogen for IVDA’s?
Staph. aureus
Major criteria for diagnosis of IE?
Positive culture (staph, strep, enterococcus or HACEK) TTE/TEE
Diagnosis of Definite IE
2 major
1 major + 3 minor
5 minor
Diagnosis of Possible IE
1 major + 1 minor
3 minor
Tx of NATIVE valve, PCN-S strep
Pen G or Ceftriaxone x 4 weeks
or
Pen G or Ceftriaxone PLUS Gent x 2 weeks
If PCN allergy, use Vanc x 4 weeks
Tx of NATIVE valve, PCN-I/R strep
Vanc x 4 weeks
Pen G or Ceftriaxone x4 wks PLUS Gent x2wks
Tx of PROSTHETIC valve, PCN-S strep
Pen G or Ceftriaxone x6 wks +/- Gent x2 wks
Vanc x6 wks if PCN allergy
Tx of PROSTHETIC valve, PCN-I/R strep
Vanc x6 wks
Pen G or Ceftriaxone PLUS Gent x6 wks
Tx of NATIVE valve, MSSA
Nafcillin or oxacillin x 6 weeks
+/- Gent x3-5 days
Tx of NATIVE valve, MSSA (w/PCN allergy)
Cefazolin x6 weeks (minor allergy)
If Anaphylaxis to PCN, use Vanc. x6 wks
Tx of NATIVE valve, MRSA
Vanc x6 weeks
Tx of PROSTHETIC valve, MSSA
Nafcillin or oxacillin >6 weeks
PLUS Rifampin >6 weeks
PLUS Gentamicin x2 weeks
Tx of PROSTHETIC valve, MRSA
Vanc >6 weeks
PLUS Rifampin >6 weeks
PLUS Gentamicin x2 weeks
When do you need to use Vanc + Gent in strep?
Never
When do you need to use Vanc + Gent in staph?
Only with PROSTHETIC valve MRSA
Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN, Gent, and Vanc - S)
Amp or Pen G x4-6 weeks PLUS Gent (makes it cidal) x4-6 weeks
Native <3months = 4 weeks,
All others x6 weeks
Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN, Streptomycin, and Vanc - S) and (Gent -R)
Ampicillin or Pen G
PLUS Streptomycin x4-6 weeks
(Use Vanc if PCN allergy)
Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN - R) and (Vanc, Aminoglycoside - S)
Vanc PLUS Gent x6 weeks
Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN, Aminoglycoside, and Vanc - R) positive for Enterococcus faecium
Linezolid >8 weeks (monitor plts) or
Quinupristin-Dalfopristin >8 weeks
Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN, Aminoglycoside, and Vanc - R) positive for Enterococcus faecalis
Ceftriaxone PLUS Ampicillin > 8 weeks
or
Imipenem/cilastatin PLUS Ampicillin > 8 wks (seizures)
Both make use of double beta-lactam therapy
How to measure DUR in IE pts and other monitoring
Set length of tx from 1st day of negative blood culture
Monitor renal fx w/Aminoglycosides >1 wk
Monitor Vanc/Gent trough concentrations
DUR for all staph IE
6 weeks (plus 2 weeks for Gent in prosthetic)
When do you use Rifampin in IE?
Tx of PROSTHETIC IE - MSSA and MRSA
