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Endocarditis Flashcards

1
Q

Endocarditis

A

inflammation of the endocardium (the membrane lining the chambers of the heart and covering the cusps of the heart valves )

can refer to infection of the heart valves

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2
Q

Endocarditis: signs and symptoms

A 
fever
chills
weakness
dyspnea
night sweats
weight loss
malaise

heart murmur (new or changing)
embolic phenomenon
splenomegaly
janeway lesions
osler nodes
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3
Q

Endocarditis: diagnosis

A

modified duke criteria (major and minor)

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4
Q

Endocarditis: major pathogens

A

streptococci
staphylococci
enterococci

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5
Q

Endocarditis: treatment approach

A

high dose parenteral bactericidal antibiotics for an extended period
(microorganisms enclosed within vegetations and fibrin deposits)

surgery (valvectomy, valve replacement)

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6
Q

Staphylococcal Endocarditis: IVDA (pathogen, valve effected, treatment)

A

S. aureus

tricuspid valve (R sided infective endocarditis)

2 week course of nafcillin or oxacillin PLUS aminoglycoside

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7
Q

Which organism is the MC cause of infective endocarditis among those with IVDA and venous catheters?

A

S. aureus

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8
Q

Which pathogen is a prominent cause of prosthetic valve endocarditis?

A

Staphylococcus epidermidis

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9
Q

Streptococcal Endocarditis

A

MCC: viridans streptococci

usually subacute

penicillin G (or ceftriaxone)

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10
Q

Streptococcal Endocarditis: viridans streptococci

A

common inhabitants of human mouth and gingiva (prophylaxis for dental work)

common cause of endocarditis in NATIVE valves

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11
Q

Enterococcal Endocarditis

A

MCC: E. faecalis

normal inhabitants of human GI tract and anterior urethra

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12
Q

HACEK organisms

A 
Haemophilus parainfluenzae
Haemophilus aphrophilus 
Actinobacillus actinomycetemcomitans 
Cardiobacterium hominis 
Eikenella corrodens 
Kingella kingae

gram negatives

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13
Q

Endocarditis: HACEK

A

native valve, community acquired

subacute

LARGE vegetations and emboli

high dose ampicillin with gentamicin for 4 weeks

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14
Q

What is the drug of choice for endocarditis?

A

beta lactam antibiotics

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15
Q

Endocarditis: Empiric Drug Therapy: Native Valve

A

vancomycin plus ceftriaxone

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16
Q

Endocarditis: Empiric Drug Therapy: Prosthetic Valve

A

vancomycin plus gentamicin plus rifampin

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17
Q

Native Valve Endocarditis: viridans group streptococci: PCN susceptible

A

4 weeks: PCN G or ceftriaxone or vancomycin

2 weeks: PCN G or ceftriaxone PLUS gentamicin

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18
Q

Native Valve Endocarditis: staphylococci

A

oxacillin sensitive and resistant drug therapy

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19
Q

Gentamicin

A

works synergistically with other agents to shorten the duration

beyond 2 weeks increases the risk for ototoxicity and nephrotoxicity

20
Q

Gentamicin: not intended for

A 
>65 years of age
children
CNVIII impairment
creatinine clearance <20mL/min
known cardiac or extracardiac abscess 
infection with Abiotrophia, Granulicatella, Gemalia
21
Q

Native Valve Endocarditis: viridans group streptococci: PCN resistant

A

PCN G (4 weeks) plus gentamicin (2 weeks)

ceftriaxone (4 weeks) plus gentamicin (2 weeks)

vancomycin (4 weeks)

22
Q

Native Valve Endocarditis: staphylococci: oxacillin susceptible

A

6 weeks:

  • nafcillin or oxacillin
  • cefazolin
  • vancomycin
  • daptomycin
23
Q

Native Valve Endocarditis: staphylococci: oxacillin resistant

A

6 weeks:

  • vancomycin
  • daptomycin
24
Q

Prosthetic Valve Endocarditis: viridans group streptococci: PCN susceptible

A

6 weeks
PCN G or ceftriaxone
2 weeks
with or without gentamicin

6 weeks
vancomycin

25
Prosthetic Valve Endocarditis: viridans group streptococci: PCN resistant
6 weeks - PCN G plus gentamicin - ceftriaxone plus gentamicin - vancomycin
26
Prosthetic Valve Endocarditis: staphylococci: oxacillin susceptible
>6 weeks nafcillin or oxacillin or vancomycin (may sub cefazolin if hypersensitivity) >6 weeks plus rifampin 2 weeks plus gentamicin
27
Prosthetic Valve Endocarditis: staphylococci: oxacillin resistant
>6 weeks vancomycin plus rifampin 2 weeks plus gentamicin
28
Native and Prosthetic Valve Endocarditis: enterococci: susceptible
4-6 weeks - ampicillin plus gentamicin - PCN G plus gentamicin 6 weeks - ampicillin plus ceftriaxone - vancomycin plus gentamicin
29
Native and Prosthetic Valve Endocarditis: enterococci: resistant
gentamicin resistant: use streptomycin penicillin resistant: 6 weeks -ampicillin sulbactam plus gentamicin -vancomycin plus gentamicin resistant to PCN, aminoglycodies, vancomycin: >6 weeks -linezolid -daptomycin
30
Endocarditis: HACEK
4 weeks - ceftriaxone - ampicillin or ampicillin-sulbactam - ciprofloxacin
31
Endocarditis: culture negative native valve
vancomycin plus cefepime or ampicillin-sulbactam
32
Endocarditis: culture negative prosthetic valve
EARLY (<1 year) 6 weeks vancomycin plus cefepime plus rifampin plus gentamicin LATE (>1 year) 6 weeks vancomycin plus ceftriaxone
33
Endocarditis: suspected Bartonella (culture negative)
6 weeks ceftriaxone 2 weeks plus gentamicin 6 weeks with or without doxycycline
34
Endocarditis: (culture positive) Bartonella
6 weeks doxycycline plus 2 weeks gentamicin
35
Daptomycin: ADE
myopathy | rhabdomyolysis
36
Gentamicin: ADE
nephrotoxicity ototoxicity neuromuscular blockade
37
Linezolid: ADE
thrombocytopenia optic neuropathy peripheral neuropathy
38
Rifampin: ADE
hepatotoxicity red/orange discoloration of bodily secretions
39
Vancomycin: ADE
nephrotoxicity red man syndrome - prolong infusion time from 1 to 2 hours - consider antihistamine prior to loading
40
Endocarditis Prophylaxis: indications
highest risk cardiac conditions - prosthetic heart valve - prior diagnosis of infective endocarditis - cardiac transplantation with valvulopathy - congenital heart disease NOT RECOMMENDED for patients who undergo GI procedure
41
Endocarditis Prophylaxis: procedures
any that require perforation of the oral mucosa or manipulation of the periapical region of the teeth or gingival tissue tooth extraction drainage of abscess routine dental cleaning
42
Endocarditis Prophylaxis: first line
oral amoxicillin | 30-60 minutes before procedure
43
Endocarditis Prophylaxis: unable to take oral meds
IM or IV ampicillin or cefazolin or ceftriaxone
44
Endocarditis Prophylaxis: allergic to PCN (oral)
oral cephalexin or clindamycin or azithromycin
45
Endocarditis Prophylaxis: allergic to PCN and unable to take oral meds
IV or IM clindamycin or cefazolin or ceftriaxone IV vancomycin

PHA 550 (26 decks)

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